When R.J., a 14-year-old baseball player, developed an increasingly severe limp, his parents suspected a sports injury. Tests, however, revealed that the teenager had chondroblastoma, an aggressive, noncancerous bone tumour that primarily affects young men. The tumour was rapidly destroying the top of R.J.’s femur, at the hip joint. Without treatment, he could lose his leg.
R.J.’s family consulted orthopaedic surgeon James Wittig, who has published nearly 100 studies evaluating innovative treatments, including limb-saving surgery for chondroblastoma and other bone tumours. R.J. underwent a five-hour operation at Atlantic Health’s Morristown Medical Center, which is ranked by US News & World Report as one of the nation’s 30 best hospitals for orthopaedics. Wittig removed the tumour, reconstructed R.J.’s hip joint with donated bone and cartilage, and performed cryosurgery, using liquid nitrogen to kill tumour cells.
“Without cryosurgery, there would have been a 60 to 80% risk that R.J.’s tumour would eventually return,” says Wittig, who is medical director, orthopedic oncology, at Atlantic Health System in New Jersey. “With this technology, the risk is less than 5%.” The young athlete made an excellent recovery, and after several months of physical therapy, resumed playing sports — with no limp or other impairment.
Wittig is planning a study to compare outcomes in patients treated using robotic techniques with those who undergo conventional surgery. Indeed, many of Atlantic Health’s physician-scientists are investigating high-tech approaches to orthopaedic and neurological conditions, including ‘smart knee’ replacements, augmented reality tools for complex shoulder procedures, a novel spine-straightening device for scoliosis, spine robots and spine navigation.
A vaccine against brain tumours
In February 2022, Atlantic Health’s Overlook Medical Center was selected as the first site in New Jersey, and one of the first three in the nation, to participate in SURVIVE. This ground-breaking clinical trial aims to test a first-of-its-kind therapeutic vaccine for glioblastoma, a fast-growing and aggressive form of glioma — the most common type of brain cancer. Called SurVaxM, the vaccine targets survivin — a cell-survival protein found in 95% of glioblastomas and many other cancers.
The goal of the multicentre phase II trial is to see whether SurVaxM extends life and improves functionality in newly diagnosed glioblastoma patients, says neuro-oncologist Robert Aiken, director of Atlantic Health’s neuro-oncology programme, and co-director of the Gerald J. Glasser Brain Tumor Center, who is leading the trial at Overlook. “Even gaining a few more years to spend with loved ones and enjoy a better quality of life would be an enormous advance for patients with this lethal cancer,” he says, adding that average survival after diagnosis is currently only 16 months.
Patients in the trial receive either the new vaccine or placebo shots, plus the standard-of-care immune-boosting drug, after they complete standard postoperative radiation and chemotherapy. Aiken notes that earlier, first-in-human studies were extremely promising1, and preliminary results from a single-arm phase IIa trial, recently presented at the 2022 ASCO meeting2, suggest the approach is effective at stimulating survivin-specific immune responses. “Although it’s too soon to tell how helpful SurVaxM will be, we’re excited about the potential of this targeted therapy.”
A flexible tether to straighten the spine
For children with severe spinal curvature due to scoliosis, the standard treatment has long been surgery to attach a metal rod to the vertebrae. Known as spinal fusion, this operation causes vertebrae to grow together over time, thereby stiffening and straightening the spine, says Jason Lowenstein, chief of scoliosis and spine deformity surgery at Morristown Medical Center.
In September 2021, Lowenstein and his team were the first in New Jersey to perform a new FDA-approved, minimally invasive scoliosis procedure called vertebral tethering, in which a flexible cord, or tether, is implanted to pull spinal bones into proper alignment. “This is an extremely exciting advance because it offers a unique flexible surgical option to treat severe scoliosis while children are still growing,” he says.
The tether works by putting pressure on one side of the spinal curve, while allowing the other to continue to grow naturally, thereby gradually straightening the spine. “This minimally invasive procedure is transforming the way we treat severe scoliosis,” adds Lowenstein. “Not only can recovery time be faster than with traditional spinal fusion, but the tether’s flexibility allows a greater range of motion, potentially enabling patients to participate in strenuous athletic activities throughout their lives.”
Augmenting reality to simplify surgery
As the US population ages, demand for joint replacement procedures has soared. In parallel, the technology used to treat painful, worn-out knees, hips and shoulders has become increasingly sophisticated. In 2021, Morristown Medical Center and Overlook Medical Center were among the first US centres to pioneer the use of ‘mixed-reality’ tools to improve outcomes in patients undergoing complex hand, arm and shoulder procedures, including shoulder replacement.
The technology involves using headsets that project holographic images next to the patient during surgery, enabling orthopaedic surgeons to combine information from preoperative planning software with real-time analysis as the operation progresses. “Mixed reality makes complex procedures easier to perform,” says Wittig. “That, along with the wealth of information this technology provides, could contribute to more precise and consistent results.”
Only about a dozen US surgeons are trained in this technology, which is still in limited release nationwide. During surgery, mixed reality provides data on the patient’s medical history, X-rays, 3D images from CT scans, and implant options as the procedure progresses. It also allows surgeons to prepare for complex procedures by rehearsing the operation on virtual 3D models of the anatomical parts they’ll be operating on.
Alongside the advances in surgical technologies, the artificial joints implanted during replacement procedures have likewise improved, reports orthopaedic surgeon John Dundon, who practices at Morristown Medical Center. Dundon is one of the principal investigators in a clinical trial evaluating the post-implantation performance of a widely available knee replacement system.
Dundon is also studying the world’s first ‘smart knee’ implant, which links the implant to sensors that capture data about the patient’s range of motion, stride length, walking speed and step count. These data can be transmitted to physicians via an app, so that they can monitor patients’ progress. And that’s not all, he says. “The technology can generate helpful reminders, such as alerting people when they need to exercise more, or to increase their range of motion.”
Smart-knee data can also detect people at increased risk for implant failure. It would enable doctors to intervene early and reduce the need for knee revision surgery, avoiding repeat trips to the operating room, says Dundon. “That could be a game-changer.”