MattHepinstallMD

Hip and knee replacement surgeon @NYULangone. Associate Professor @NYUSchoolofMed. Opinions are my own.

[MattHepinstallMD @HepinstallMD]

@BrianChalmersMD @AAHKS_YAG @ArthroToday @ACR_MD @jaimelbellamyDO @CenterRotation @drsebheaven @DrLeeRubin @djschuett @NaanDerthaal @bethgausdenmd @kate_wynne Robot with 3D spinopelvic planning adds value for posterior. Fluoroscopy can do the job for anterior hips. Radlink, Orthogrid, or similar give nice secondary checks. Robot nice with abnormal anatomy and can minimize or avoid fluoro.

[MattHepinstallMD @HepinstallMD]

@DominicMarley @drsebheaven @jointdocShields @BrianChalmersMD @BennerKneeMD @stevemchale @ChrisGraysonMD1 @KevinParkMD @orthobullets @HMethodistMD @bethgausdenmd @EdinburghKnee @tdd340 @NaanDerthaal @itius @JArthroplasty Robot is a tool. It requires smart use to make a big difference. 3D planning has evolved past 40/20 and is very powerful if used to its potential. Our data come from a large academic medical center where hip/spine planning is routine. Accuracy matters with the right target!

[MattHepinstallMD @HepinstallMD]

@PeltMD Strong work turning the implicit knowledge of surgeons experienced in DA w/ fluoro into explicit knowledge that can be taught! This sign reflects lack of jump distance at the articulation 180 degrees away from the AIIS (the primary source of bone impingement in THA. Beware!

[MattHepinstallMD @HepinstallMD]

@centerofhip Yup.

Primary source of bone impingement on pelvis is the AIIS and subspine.

Makes sense to optimize jump distance 180 degrees from zone of impingement if/when one can do so without substantially decreasing impingement-free ROM.

[Hospital for Special Surgery (HSS) @HSpecialSurgery]

A study published in @Nature conducted by the Accelerating Medicines Partnership (AMP) and led by co-senior author Dr. Laura Donlin (@Donlinlab) unveils new subtypes of rheumatoid #arthritis based on molecular patterns.

https://t.co/r6dIvfR1Iu

[MattHepinstallMD @HepinstallMD]

@JArthroplasty Sounds like the surgeon should use the approach that allows easiest access to the hip for a given patient. Surgeon skill with approach matters, as do patient factors including body habitus. The easier the access, the easier the recovery, and the better the outcome.

[MattHepinstallMD @HepinstallMD]

@wkvasileff @W1ldMD @generalorthomd @pmangoneMD @HeatherUpLeft @Nawashi3332 @CenterRotation @hjluks The key is the expectation. Admit patients based on expectation they need 2 midnights. If expectation legitimate & clearly documented upon admission, and they received inpatient level of service while in hospital, correct to bill as inpatient even if discharged earlier.

[MattHepinstallMD @HepinstallMD]

@hjluks @kneeguyuk Exactly

[MattHepinstallMD @HepinstallMD]

@kneeguyuk @hjluks These patients often find non-op pain relief frustratingly inadequate in first several weeks, but can do very well after a few months. They don’t do well with arthroscopy or with acute arthroplasty (joint was too good before event) but may need arthroplasty in long run.

[MattHepinstallMD @HepinstallMD]

@ashtongoldmanmd Impingement matters but jump distance and capsular integrity determine which impinging hips actually dislocate.

[MattHepinstallMD @HepinstallMD]

@ashtongoldmanmd In my experience changing to anterior approach (with fluoroscopic navigation and routine use of biggest available fixed-bearing head) has made the biggest difference. Institutional data says robotics makes a bigger difference (write-up in progress) than approach alone.

[MattHepinstallMD @HepinstallMD]

@schulte_ss Lack of data on approach and on use of precision technology are major acknowledged limitations of this study. Reworking the database to capture these data for future studies.

[MattHepinstallMD @HepinstallMD]

Well, that’s disappointing. Selective use of dual-mobility did not measurably reduce 90-day dislocation, readmission or reoperation risk after primary total hip arthroplasty. https://t.co/CrjN1dfm13

[MattHepinstallMD @HepinstallMD]

@ashtongoldmanmd These data do not refute the likelihood that specific DM designs may be helpful in specific indications. We may not be allocating DM optimally. Different DM designs might have different efficacy. Anterior surgery and robotics may mask benefits of DM in manual posterior surgery.

[MattHepinstallMD @HepinstallMD]

@ashtongoldmanmd It certainly could be. Impossible to retrospectively eliminate confounding. We tried to control for this by comparing dislocation rates of surgeons who used dual mobility frequently to those who used it sparingly. Surgeons who used more DM did not achieve lower rates.

[MattHepinstallMD @HepinstallMD]

@moreyraortho @JArthroplasty Turns out jump distance may be even more important than impingement-free ROM.

[MattHepinstallMD @HepinstallMD]

@OrthoSummit swag on Spring Break.

[MattHepinstallMD @HepinstallMD]

@OrthoSummit Great meeting! Countless opportunities to learn from & connect with peers & experts. I particularly enjoy meeting the next orthopedic generation through the fellow, resident & student research program. Truly a privilege and a pleasure to participate. Always time well spent.

[MattHepinstallMD @HepinstallMD]

@JennaKoblinski Patients & medical team can be imprecise in thinking, speaking & listening. Multiple confirmations of history are valuable. Talking about health is difficult. You played an important part in that patient’s care as she struggled to convey her symptoms effectively.

[MattHepinstallMD @HepinstallMD]

@mattbarbermd @generalorthomd @jointdocShields @BrianChalmersMD @drsebheaven @NaanDerthaal @CenterRotation I had the same thought when I first helped revise one of these as a resident in 2003. Outdated for 20 years! I have only encountered a handful of these stems but they should go away.