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Montefiore in the News

March 11, 2020

“Tripod” Technique Reduces Pain and Is Safer Than Traditional Open Surgery; Findings Published in The Journal of Bone and Joint Surgery

NEW YORK – Thousands of patients whose cancer has spread to the bones could benefit from a new minimally invasive approach to fixing painful pelvic fractures, according to a study conducted by orthopedic oncology surgeons at Montefiore Health System.

If cancer spreads from the primary location to the bones, it can cause them to weaken and eventually fracture. Pelvic fractures cause debilitating pain and make it extremely difficult to walk. Traditionally, surgeons perform a total hip replacement to reduce pain and improve quality of life. While this approach is often successful, it is major surgery and comes with risks, including significant blood loss, extended time under anesthesia, risk of infection, risk of dislocation and the need for a longer hospitalization.

Orthopedic oncology surgeons at Montefiore are the first to use a novel approach called the “tripod” technique, for patients with pelvic lesions caused by cancer. This technique uses multiple screws that are placed through very small incisions, connecting the damaged bones and stabilizing the pelvis. It is called “tripod’ because the screws are placed in a tripod configuration to support the socket of the hip joint.

“This approach goes against the conventional notion that bone affected by cancer is too weak and needs to be completely replaced,” said lead author Rui Yang, M.D., orthopedic surgeon, Montefiore, and assistant professor, Albert Einstein College of Medicine. “Our study shows that using this technique means patients don’t need to undergo a longer, more aggressive surgery. They recover and go home quicker, have less pain, and most importantly, can resume therapies targeted at treating their cancer.”

This project is part of a larger research effort by the Division of Orthopaedic Oncology that includes the Musculoskeletal Oncology Research Laboratory, which performs basic and translational research as part of the National Cancer Institute-designated Albert Einstein Cancer Center. Their projects focus on rare primary bone and soft-tissue tumors, including osteosarcoma and synovial sarcoma. In addition, the Division of Orthopaedic Oncology routinely participates in a number of institutional and multi-center clinical studies spanning various aspects of orthopaedic oncology. The doctors have presented their findings at several national and international meetings, showing the “tripod” technique is safe, effective, and extremely well-tolerated by patients who were bedridden, in wheelchairs or using assistive devices to walk prior to the procedure.

“We are pleased to find this technique results in better outcomes for our patients,” said co-author David Geller, M.D., orthopedic oncologist and vice-chairman, Strategy and Innovation, Orthopaedic Surgery, Montefiore and associate professor of Orthopedic Surgery and Pediatrics, Albert Einstein College of Medicine. “And we are surprised to find that despite conventional wisdom, many of our patients heal their fractures and experience new bone growth.”

One patient who benefitted from the “tripod” technique is 58-year-old, 9/11 survivor, Nancy Toussaint. Nancy, who is the caregiver for her elderly parents, was running errands one day when she felt her hips “shift.” She managed the discomfort for a few weeks but decided to seek medical advice. Doctors discovered her pelvic bone had fractured as the result of cancer spreading throughout her body. Nancy underwent the “tripod” surgery in September to repair the pelvic fracture and is now undergoing cancer therapy.

“Most of the patients in this study were able to get out of bed and bear weight on the same day as the surgery,” said Dr. Yang. “None of them needed a blood transfusion and there were no wound-healing issues. We hope that other surgeons will consider this approach so that patients have one less issue to deal with, while they undergo cancer treatment.”

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About Montefiore Health System

Montefiore Health System is one of New York’s premier academic health systems and is a recognized leader in providing exceptional quality and personalized, accountable care to approximately three million people in communities across the Bronx, Westchester and the Hudson Valley. It is comprised of 10 hospitals, including the Children’s Hospital at Montefiore, Burke Rehabilitation Hospital and close to 200 outpatient care sites. The advanced clinical and translational research at its medical school, Albert Einstein College of Medicine, directly informs patient care and improves outcomes. From the Montefiore-Einstein Centers of Excellence in cancer, cardiology and vascular care, pediatrics, and transplantation, to its preeminent school-based health program, Montefiore is a fully integrated healthcare delivery system providing coordinated, comprehensive care to patients and their families. For more information please visit www.montefiore.org. Follow us on Twitter and view us on Facebook and YouTube.

About Albert Einstein College of Medicine Albert Einstein College of Medicine is one of the nation’s premier centers for research, medical education and clinical investigation. During the 2019-20 academic year, Einstein is home to 724 M.D. students, 158 Ph.D. students, 106 students in the combined M.D./Ph.D. program, and 265 postdoctoral research fellows. The College of Medicine has more than 1,800 full-time faculty members located on the main campus and at its clinical affiliates. In 2019, Einstein received more than $178 million in awards from the National Institutes of Health (NIH). This includes the funding of major research centers at Einstein in aging, intellectual development disorders, diabetes, cancer, clinical and translational research, liver disease, and AIDS. Other areas where the College of Medicine is concentrating its efforts include developmental brain research, neuroscience, cardiac disease, and initiatives to reduce and eliminate ethnic and racial health disparities. Its partnership with Montefiore, the University Hospital and academic medical center for Einstein, advances clinical and translational research to accelerate the pace at which new discoveries become the treatments and therapies that benefit patients. Einstein runs one of the largest residency and fellowship training programs in the medical and dental professions in the United States through Montefiore and an affiliation network involving hospitals and medical centers in the Bronx, Brooklyn and on Long Island. For more information, please visit www.einstein.yu.edu, read our blog, follow us on Twitter, like us on Facebook, and view us on YouTube.