Innovative HSS Research on COVID-19 Will Investigate Issues in Orthopaedics

    The Hospital for Special Surgery has funded 9 grants for projects related to the study of COVID-19, including 3 of particular interest to surgeons who perform joint arthroplasty:

    Response to and Recovery from TKA in Patients with Antibodies to SARS-CoV-2
    Principal Investigator: Miguel Otero, PhD
    Co-Investigators: Meghan Kirksey, MD, PhD, and Peter K. Sculco, MD

    It is unknown if patients who have been exposed to COVID-19 may be at higher risk of experiencing an abnormal immune response following surgery, resulting in poor outcomes. This study will evaluate the response to and recovery from total knee arthroplasty (TKA) in patients who have antibodies to COVID-19, a marker of exposure.

    This study will include both patients who have COVID-19 antibodies and those who do not, to act as controls. Patients will be followed for 6 weeks after surgery and evaluated for the presence of certain immune markers in the blood, as well as symptoms of inflammation such as pain and stiffness in the joint.

    Assessment of Surgical Outcomes in the COVID-19 Pandemic Era
    Principal Investigator: Andy O. Miller, MD
    Co-Investigators: Scott A. Rodeo, MD, and Mark Fontana, PhD

    Investigators will implement a patient registry to evaluate how COVID-19 affects outcomes and complication rates after orthopaedic surgery. This registry, along with COVID-19 screening procedures, will provide the tools to address specific research questions. Among these questions are determining the incidence of current and prior infection among the HSS surgical population, the clinical features associated with current and prior infections in this patient population, and whether COVID-19 status affects short-term complication rates.

    Prediction and Prevention of Postoperative Blood Clots in COVID-19 Patients
    Principal Investigators: Friedrich Boettner, MD; Kethy M. Jules-Elysee, MD; and Lisa A. Mandl, MD, MPH
    Co-Investigators: Alejandro Gonzalez Della Valle, MD; Jason Blevins, MD; David J. Mayman, MD; Peter K. Sculco, MD; Geoffrey H. Westrich, MD; Thomas P. Sculco, MD; Medha Barbhaiya, MD, MPH; Doruk Erkan, MD, MPH; Deanna Jannat-Khah, DrPH; Thomas W. Bauer, MD, PhD; Stavros G. Memtsoudis, MD, PhD, MBA; Alexandra Sideris, PhD; Amethia Joseph, MHA; Ethan Krell, MS; and Raymond David Pastore, MD

    Recent literature suggests that one of the major complications seen in patients with COVID-19 is thrombosis due to endothelial dysfunction, persistent inflammation, and potentially antiphospholipid antibodies. As elective surgeries resume, those with prior exposure to SARS-CoV-2 will inevitably present for treatment, and some may have perioperative management considerations related to their risk of deep vein thrombosis.

    This project will use a non-invasive device that can determine clotting risks to investigate whether people who have had COVID-19 have a more dysfunctional endothelium preoperatively and at 24 hours after surgery. The investigators will measure antiphospholipid antibodies and inflammatory markers and evaluate the prevalence of asymptomatic postoperative deep vein thrombosis in patients who undergo TKA and have SARS-CoV-2 antibodies.