“It is an honor to receive the Health Care Heroes Lifetime Achievement Award. It has special meaning for me, as it recognizes my accomplishments in improving orthopedic care for people on Long Island and my work in educating many orthopedic surgeons now practicing here,” Dr. Dines said. “It represents a wonderful affirmation that I've been able to make a difference in the lives of many Long Islanders over the years.”

Over his 45-year career, Dr. Dines earned a reputation as a skilled and meticulous orthopedic surgeon; a brilliant thought leader; and an inspirational mentor to hundreds of medical students, orthopedic residents and fellows. He has provided the highest quality care to thousands of Long Islanders to help them overcome pain and return to active, healthy lifestyles.

Dr. Dines is a member of the Sports Medicine Institute at HSS and sees patients at HSS Long Island in Uniondale. He serves as medical director of the HSS Education Institute and has held the position of co-chief of the highly regarded shoulder fellowship at HSS since 2017. 

Considered one of the foremost authorities in shoulder replacement surgery worldwide, Dr. Dines has pioneered innovative techniques and surgical implants. Known for his work with professional athletes, he has served as medical director of the Association of Tennis Professionals (ATP) Tour since 2000. He was a team physician for the Long Island Ducks baseball team from 2000 to 2020, and for the New York Mets from 1992 to 1996. 

Dr. Dines has received a number of awards over the years. In 2024, the Middle Atlantic Shoulder and Elbow Society honored him with its Lifetime Achievement Award. He continues to conduct research to advance the field of joint replacement surgery.  

This innovative surgery revolutionizes conventional anatomical stemmed total shoulder replacement, using an elliptical-shaped head which is anatomically matched to the ovoid shape of the ball-and-socket joint in the human shoulder. The stemmed elliptical head enables surgeons to readily convert an anatomic total shoulder replacement prosthesis to a reverse shoulder replacement prosthesis, should a revision surgery ever be needed in the future. Dr. Blaine is the first surgeon in the world to use this advanced technology, placing an elliptical head on a stemmed implant.

Anatomic total shoulder replacement arthroplasty is often advised for patients with osteoarthritis. This surgery replaces the ball and socket with artificial components, allowing younger patients to stay active and play sports. Reverse shoulder replacement is advised when patients have both arthritis and a deficient rotator cuff. The natural positions of the ball and socket are switched. A metal ball implant is placed where the patient's own natural socket was, and a plastic socket implant is placed on the top of the humeral head.

For the past 50 years, since they were first introduced by Dr. Charles Neer in the 1970s, the heads of the prostheses used in shoulder replacement surgeries have been spherically shaped. In the last several years however, two manufacturers have introduced elliptical heads which may improve range of motion and healthy shoulder functionality over spherical heads, according to some biomechanical and clinical studies.

“The main reason for implanting a convertible prosthesis in a patient’s shoulder is that an anatomic shoulder replacement provides a more normal shoulder than a reverse prosthesis in active patients.  However, if a patient ever had an injury or tear of the rotator cuff in the future, we now have better options with a stemmed prosthesis,” explains Dr. Blaine. “Up until now, we haven’t had convertibility from a standard ball-and-socket prosthesis to a reverse prosthesis. The stemmed elliptical head prosthesis for anatomic replacement gives us the ability to make this conversion in a more expedient way without having to remove the stem.”

“One of our primary goals at HSS is to reproduce or recapitulate the human anatomy,” Dr. Blaine adds. “The normal anatomy of the shoulder joint is an egg-shaped head, not a sphere. This new approach allows us to get closer to replicating the normal function of the human shoulder so patients can remain active well into their later years.”

These first procedures using elliptical head prostheses at HSS Stamford have been successful, and the technology is now being used at multiple centers throughout the U.S. Dr. Blaine also reports that HSS will soon be conducting a motion analysis study in conjunction with other institutions to compare shoulder replacement patients who received oval-shaped heads versus those who received spherical heads.

The U.S. Food & Drug Administration recently approved liposomal bupivacaine for use in interscalene nerve blocks. Liposomal bupivacaine is an extended-release formulation of bupivacaine that theoretically sustains pain relief up to 72 hours. However, there is a lack of randomized controlled trials comparing liposomal bupivacaine with placebo (saline) or with “standard” bupivacaine. 

Investigators aimed to determine whether liposomal bupivacaine actually prolongs pain relief compared with standard bupivacaine plus dexamethasone as a regional anesthetic technique. HSS has been using standard bupivacaine with perineural dexamethasone as an adjuvant in order to lengthen pain relief from nerve blocks up to 30 hours, as there are several meta-analyses and systematic reviews supporting its safe and effective use in upper extremity blockade. This study is the first randomized controlled trial comparing the two drugs as injectates in nerve blocks.

Study on prolonging nerve blocks is imperative, as “prolonging analgesia with adjuvants may be key in decreasing opioid use after surgery,” said Dr. David Kim, anesthesiologist at HSS.

The study was conducted from August 2019 to March 2021 in 112 patients undergoing ambulatory shoulder surgery. Participants were divided into two groups: 56 patients who received a mixture of 5 mL of 0.5% standard bupivacaine with 133 mg of liposomal bupivacaine; and 55 patients who received a mixture of 15 mL of 0.5% standard bupivacaine with 4 mg of dexamethasone. 

The primary outcome was average numerical rating scale (NRS) pain scores at rest over a period of 72 hours, but the researchers also examined analgesic block duration, motor and sensory resolution, opioid use, and NRS pain scale scores when resting and moving on days 1, 4 and 7 after surgery. They also examined patient satisfaction, readiness for PACU discharge, and adverse side effects related to the interscalene block. 

The results indicated that the pain score after 72 hours in the liposomal bupivacaine group was non-inferior to the bupivacaine with dexamethasone group (mean (SD), 2.4 (1.9) versus 3.4 (1.9), mean difference (95%CI), -1.1 (-1.8, -0.4), p <0.001 for noninferiority). Additionally, there was also no significant difference in the length of pain relief between the two groups. Furthermore, there was no difference in opioid consumption, readiness for PACU discharge, or adverse events. 

“Liposomal bupivacaine is noninferior to preservative-free dexamethasone when used as an adjuvant for the interscalene nerve block,” Dr. Kim noted. “Even though there was a statistically significant difference in the pain scores, the differences are unlikely to be clinically relevant. As practicing clinicians, it was important for us to investigate interventions that provide meaningful clinical differences, not to only look for statistical significance in numbers.”

Dr. Kim concluded “Follow up research should include a large prospective randomized controlled trial comparing liposomal bupivacaine and preservative-free dexamethasone on total shoulder arthroplasties.”

Reference

1. Danya A. DeMeo BS, Ejiro Gbaje MPH, Jacques T. YaDeau MD PhD, Kethy M. Jules-Elysee MD, Yi Lin MD PhD, Enrique A. Goytizolo MD, David Kim MD, Richard L Kahn MD, Stephen C. Haskins MD, David J. Mayman MD, Douglas E. Padgett MD, Thomas P. Sculco MD, Chad M. Brummett MD, Geoffrey Westrich MD. “Interscalene brachial plexus block with liposomal bupivacaine versus standard bupivacaine with perineural dexamethasone: a noninferiority trial.” Presented at: 47th Annual Regional Anesthesiology and Acute Pain Medicine Meeting of the American Society of Regional Anesthesia and Pain Medicine (ASRA), March 31-April 2, 2021; Las Vegas, NV.

The glenoid is the socket part of the shoulder joint that connects to the ball of the upper arm bone. Glenoid bone loss can occur due to severe arthritis, traumatic injury or repetitive overuse in sports like baseball or swimming. It can also occur as a result of failed previous surgery. Symptoms associated with glenoid bone loss include inflammation, pain and decreased shoulder function.

“Shoulder arthroplasty to address glenoid deficiency is a very hot topic right now as we’re seeing more patients with arthritis and younger patients with complex anatomical issues,” said Dr. Dines. “Up to 10 or 15 years ago, we didn’t have much to offer. Today, we have advanced surgical techniques and a range of implant options for restoring mobility and improving patients’ quality of life.”

During the session, eight cases of varying levels of glenoid bone deficiency were presented for consideration by session attendees divided into groups at discussion tables. Members of an international panel of leading shoulder surgeons from the United States, France and Italy guided discussions at each table as participants formulated potential surgical approaches for each case. After groups shared their proposed approaches in a round-robin format, it was presented how HSS treated the cases. Attendees then had an opportunity to discuss and critique the solutions.

Session participants learned about the latest innovations for addressing glenoid bone loss, starting with advanced diagnostic imaging and pre-op planning systems used at HSS, one of the institutions with this capability.

Surgical approaches presented included two bone grafting techniques: bony increased offset-total shoulder arthroplasty (BIO-TSA) and bony increased offset-reverse shoulder arthroplasty (BIO-RSA). The latter reverses the ball and socket components of the joint for increased stability. Another case illustrated an augmented glenoid implant, which uses a metal or polyethylene wedge or a larger metal plate to replace bone loss. HSS has been at the forefront of developing augmented glenoid implants, Dr. Dines said.

Three complex cases of significant bone loss highlighted the use of patient-specific implants, the latest innovation in the field pioneered at HSS by Dr. Dines and colleagues. Known as the glenoid vault reconstruction system (VRS), it is used for patients with significant loss of bone and supporting joint structure. “We create a customized implant for each patient, based on 2D and 3D CT scans,” he explained. “The VRS works well to address severe bone loss in patients with advanced rheumatoid arthritis, after tumor removal or for revisions.” Dr. Dines said he looks forward to presenting results on treating about 75 HSS patients with the VRS at next year’s AAOS annual meeting.

“It’s an exciting time for advances in shoulder arthroplasty,” he concluded. “Our interactive session sparked many fruitful discussions that I hope will lead to increased shared learning and the development of more innovations for improving patient outcomes.”

“We are dedicated to providing outstanding medical care to elite athletes, and our designation as a FIFA Medical Centre of Excellence by the Feder the Fédération Internationale de Football Association recognizes our expertise and enthusiasm in treating professional soccer players,” said Dr. Williams. “With the new members of the medical team, we will continue to provide the high level of care Red Bull players depend on to be their best on the field and to get back in the game if they sustain an injury.”

A nationally recognized leader in cartilage repair and restoration, Dr. Williams specializes in knee, shoulder, and elbow surgery at the HSS Sports Medicine Institute. Along with the Red Bulls, Dr. Williams serves as medical director and head team physician for the Brooklyn Nets (NBA), Long Island Nets (G-League), and New York Liberty (WNBA), and as a team physician for USA Basketball.

The new members of the medical team are highly specialized in treating a wide range of orthopedic injuries.

Danyal H. Nawabi, MD, an orthopedic surgeon in the HSS Sports Medicine Institute, specializes in knee, shoulder, and hip surgery, including arthroscopic procedures and joint replacement.

Orthopedic surgeon Andrew J. Elliot, MD, treats conditions of the foot and ankle, including athletic injuries, bunions, tendon tears and ruptures, hammertoes, osteochondritis dissecans, fractures and arthritis.

Benedict Nwachukwu, MD, is an orthopedic surgeon and specialist in hip, knee and shoulder surgery at HSS. Along with the Red Bulls, Dr. Nwachukwu serves as a team physician for the New York Liberty and medical consultant for the National Basketball Players Association.

About the New York Red Bulls

The New York Red Bulls are one of 27 teams in Major League Soccer (MLS). RBNY, one of the ten charter clubs of MLS, have competed in the league since its founding in 1996. The Red Bulls play home matches at Red Bull Arena (RBA) in Harrison, New Jersey.The three-time MLS Supporters' Shield Winners are owned by the Austrian beverage company Red Bull for which the team is named. The New York Red Bulls offer one of the nation's premier youth soccer development programs, from local soccer partnerships across New York and New Jersey to Regional Development Schools and the Red Bulls Academy teams.

“I have always been a very active, outdoorsy nature lover, enjoying activities such as mountain climbing, biking, kayaking and rock-climbing all around the world with my family, as well as ballet dancing,” Ms. Hitchcock wrote on “Back in the Game,” the HSS patient blog. “By 2009 I was in constant pain and barely able to walk, much less dance or climb. Within a month of my total knee replacement I was back in the ballet studio doing my barre exercises and I climbed Mt Katahdin in Maine, crossing the ‘Knife’s Edge’ 11 months later. Dr. Westrich truly gave me back my life! With my new knee I was able to take a rock-climbing trip to Thailand in 2014 to celebrate our children’s’ PhDs! What fun!”

Over the years, Ms. Hitchcock has enjoyed numerous active vacations with her family. She has visited Zimbabwe, Botswana, Borneo and other exotic locales. In addition to climbing, she continues to go hiking, bicycling and has taken up snorkeling. She recently returned from an adventure vacation in New Zealand with her husband and daughter, which included mountain climbing and kayaking.

Ms. Hitchcock is among a growing number of baby boomers who refuse to slow down, despite joints worn out by years of activity, an injury or the passage of time. “I’m seeing more people in their 40’s and 50’s who refuse to be sedentary and, like Diane, will do what it takes to enjoy their active lives,” Dr. Westrich says. “Over the past few years, advances in joint implant design and surgical technique provide even more options for younger patients.” Robotic-assisted surgery and a newer cementless implant could lead to a longer-lasting knee replacement, he says.

Along with Dr. Westrich, Ms. Hitchcock credits two other highly specialized orthopedic surgeons at HSS with helping her maintain her active lifestyle. In addition to her knee replacement at age 56, she had a spinal fusion with Dr. Federico Girardi in 2017 and shoulder replacement surgery with Dr. Lawrence Gulotta in 2018.

She says each surgery has helped her enjoy life again. “Never once did any of my doctors at HSS express the notion that these goals were too extreme for someone my age,” she explains. Major surgery is never a walk in the park, but Ms. Hitchcock didn’t hesitate. She took each surgery and recovery very seriously, taking time off from work and vigorously adhering to her physical therapy regime after each procedure. She speaks very highly of all three of her HSS physicians, and says she had excellent outcomes after surgery.

 Her doctors applaud the motivation of Diane and others who wish to enjoy the physical and psychological benefits of exercise at every age. “Why give up years of an active lifestyle,” Dr. Westrich says, “when newer options are available to allow patients with arthritis or another orthopedic condition to live life to the fullest?”