2023 Recap: Bone and Joint Institute Research Initiatives

The Bone and Joint Institute (BJI) is a co-management operation between Orthopedic Associates of Hartford and Hartford Healthcare, to provide excellent orthopedic clinical care to patients.

Each year, BJI invests resources to develop, implement, and publish innovative musculoskeletal research to continually improve patients’ quality of care, health, and well-being. Investing in research aligns with its goal to build a national research reputation and center supporting orthopedic studies and trials. Since its opening in January 2017, BJI has built a reputation of being at the forefront of research to learn optimal techniques and improve patient outcomes.

Dr. Heeren Makanji, Orthopedic Spine Surgeon at OAH is the Research Director at BJI, starting in that role in March of 2023. In this role, he manages a team of senior scientists, research assistants, data analysts, and clinical study specialists to further the research goals of BJI. The research department provides the infrastructure that translates ideas into meaningful contributions in orthopedic surgery.

In 2023, the Bone and Joint Institute completed a multitude of abstracts, peer-reviewed publications, clinical trials, and podium presentations.

2023 Abstracts

1. Esmende S, Pavano C, Silver J, Ballas N, Solomito MJ, Kostyun R. Marijuana use is associated with decreased opioid in lumbar spine fusion patients.  LSRS, May 11, 2023. Chicago IL.
2. Esmende S, Kostyun R, Solomito MJ, Inflammatory Bowel Disease a Risk Factor for Post-Surgical Infections Following Lumbar Fusion: A Large Database Study.  LSRS, May 11, 2023. Chicago IL.
3. Makanji H, Gleeson M, Solomito MJ, Esmende S. Low BMI Patients Undergoing an Anterior Lumbar Fusion Have an Increased Risk of Post-operative Complications: A Large Database Study.  LSRS, May 11, 2023. Chicago IL.
4. Makanji H, Solomito MJ, Kostyun R, Esmende S. Association between cannabis Use and Complications Following Lumbar Fusion: A Large Database study.  LSRS, May 11, 2023. Chicago IL.
5. Strecker S, Witmer D, Grady-Benson J, Carangelo R. Preoperative Post-Void Residual Bladder Scans Predict Postoperative Catheterization Following Total Knee Arthroplasty. AAOS 2023 Annual Meeting, March 7-11 2023, Las Vegas NV.
6. Kostyun R, Solomito MJ, Rios C, Lucchio P, Nissen C. Incidence of psychological conditions in patients following anterior shoulder instability: A comparison between surgery, rehabilitation, and observational treatments AOSSM July 6, 2023, Washington D.C
7. Contillo A, Kostyun R, Grady-Benson J, Rodriguez N. Peri-operative Protein Intake Assessment in Total Knee and Hip Arthroplasty Patients – A Study Protocol. American Society for Nutrition’s flagship meeting, July 22, 2023; Boston MA.
8. Longo L, Kostyun R, Witmer D, Grady-Benson J. Multiple Modifiable Risk Factors on Postoperative Adverse Outcomes after Total Joint Arthroplasty. AAHKS Annual Meeting, Nov 2, 2023, Dallas, TX

Peer-reviewed Publications

1. Barkay G, Solomito MJ, Kostyun R, Esmende S, Makanji H. The effect of cannabis use on postoperative complications in patients undergoing spine surgery: A national database study. NASSJ. 2023; Aug. 100265

Objective: With the increased use of cannabis in the US, there is a significant need to understand the medical complications associated with its use in relation to a surgical population.
Summary: Patients who were known chronic users of cannabis before their lumbar spine fusion had slightly higher complication rates than those patients who did not use cannabis. Cannabis users who also smoked tobacco products were at a greater risk of postoperative medical complications compared to control, cannabis-only, or tobacco-use-only patients, suggesting cannabis and tobacco products may have a synergistic negative effect on patients.

2. Makanji H, Solomito MJ, Maffeo-Mitchell C, Esmende S, Finkel K. Utility of erector spinae plane blocks for postoperative pain management and opioid reduction following lumbar fusions. Clinical Spine Surg. 2023;36(4)E131-4.

Objective: The purpose of this study was to determine the utility of the erector spinae plane regional anesthesia (ESP) block in reducing opioid medication usage for patients undergoing either a posterior or transforaminal lumbar interbody fusions (PLIF/TLIF).
Summary: Posterior lumbar Interbody fusion surgery (PLIF) is a surgical technique that can alleviate lower back pain and/or leg pain by removing a damaged spinal disc and fusing the pain-generating spinal segment. Erector spinae plane (ESP) block is a newer approach to pain management for a variety of surgical procedures. Utilization of the ESP block in patients undergoing posterior-based spine fusions can reduce postoperative pain by 16% and opioid consumption by 35% without increasing complication rates compared to those who did not receive a block. 

3. Makanji H, Solomito MJ, Kostyun R, Esmende S. Influence of anxiety and depression following lumbar spine fusion: A large database study . Clinical Spine Surg. 2023; epub ahead of print.

Objective: The purpose of this study was to understand how a mental health disorder, specifically anxiety and depression, influences a patient’s postoperative opioid needs following single-level lumbar spine fusion.
Summary: Patients with a diagnosed mental illness may present as more complex patients but do not need increased opioid doses for postoperative pain control.

4. Makanji H, Solomito MJ, Kostyun R, Esmende S. Influence of anxiety and depression on opioid use following cervical spine fusion: An analysis of a national claims database. Orthopedics. 2023; epub ahead of print.

Objective: Patients with spine pathology demonstrate an above-average rate of active psychiatric disorders, which can influence their recovery. This study was designed to understand how mental health diagnoses (ie, anxiety and depression) influence a patient’s postoperative need for opioids after a single-level cervical spine fusion. 
Summary: Patients who had a formally diagnosed mental disorder of anxiety or depression were less likely to fill opioid prescriptions than patients with no known mental illness diagnosis.

5. Silver J, Pavano C, Bellas N, Hewitt C, Torre B, Solomito MJ, Kostyun R, Esmende S. Cannabis use is associated with decreased opioid prescription fulfillment following single level anterior cervical discectomy and fusion (ACDF). NASSJ. May 100226.

Objective: Recently, there has been increasing legalization of marijuana within the US, however, data are mixed concerning its efficacy in treating acute pain. Our goal was to identify a difference in opioid utilization in patients with known cannabis use before anterior cervical discectomy and fusion (ACDF) compared with those who reported no cannabis use.
Summary: Patients undergoing a single-level ACDF and chronic cannabis users were found to be less likely to use opioids for pain control following their cervical fusion procedure.

6. Davis, Stephen L., Solomito, Matthew J., Kumar, Mandeep. Intravenous Versus Locally Injected Tranexamic Acid in a Fragility Hip Fracture Population: A Retrospective Review. Journal of Orthopaedic Trauma. 2024; 38(3):p e79-e84.

Objective: Evaluate differences between blood transfusion and complication rates among fragility hip fracture patients treated with locally injected (Local TXA) versus intravenous tranexamic acid (IV TXA).
Summary: IV TXA significantly reduced the risk of postoperative blood transfusion in patients undergoing surgical repair for a fragility hip fracture by 48% compared to patients receiving a locally injected TXA. There was no increased risk of complications, and a lower 30-day readmission was also observed for the IV TXA group. 

7. Magaldi RJ, Strecker SE, Nissen CW, Witmer DK, Carangelo RJ. Preoperative Bladder Scanning Can Predict Postoperative Urinary Retention Following Total Joint Arthroplasty. JBJS. 2024 epub ahead of print.

Objective: As total joint arthroplasty (TJA) moves to the outpatient setting, it is becoming clear that postoperative urinary retention (POUR) is a potential impediment to same-day discharge. The purpose of this study was to determine whether preoperative symptom surveys and bladder scanning are useful tools in identifying POUR risk.
Summary: Preoperative ultrasound bladder scanning should become the standard preoperative practice in TJA. The risk of postoperative catheterization increased as preoperative urinary volume increased from 50 to 200ml.

Clinical Trials

Prospective, Randomized, Controlled, Blinded Pivotal Study In Subjects Undergoing A Transforaminal Lumbar Interbody Fusion (TLIF) At One Or Two Levels Using Infuse™ Bone Graft with an Intervertebral Body Fusion Device and Posterior Supplemental Fixation For The Treatment Of Symptomatic Degenerative Disease Of The Lumbosacral Spine

Lead investigator: Dr. Heeren Makanji
Sub-investigators: Dr. Cameron Kia, Dr. Hanbing Zhou, Dr. Sean Esmende, Dr. Jesse Eisler

Medtronic product Infuse (BMP) helps with healing spinal fusion and is looking to get FDA approval for use in a transforaminal lumbar interbody fusion surgery. This is a global, multi-site clinical trial, and the Bone and Joint Institute is the only site In Connecticut conducting this research – a joint effort between OAH surgeons, the Bone and Joint Institute, and Medtronic. In general, studies such as these put us at the forefront of spine research and emphasize better patient outcomes. This study in particular will provide the standard of care with the added possibility of receiving a special chemical BMP sponge that will augment fusion healing – as the sponge dissolves, the BMP stimulates cells to produce new bone. Patients will not get anything that detracts from their outcome. Learn more about the study.

Recruitment

Dr. Esmende and Dr. Makanji have made BJI one of the most successful recruitment sites for multiple studies through NuVasive for XLIF (extreme lateral interbody fusion for lower back surgery), ALIF (anterior lumbar interbody fusion for low back surgery), TLIF (spine fusion surgery), and ACDF (anterior cervical discectomy and fusion for neck surgery). Active recruitment is ongoing.