Surgeon Voice
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Patients Waiting Too Long to Undergo Knee Replacement
When to get married? When to quarantine? When to have a total knee replacement? A new study can’t help much with the first two, but as for the third, Hassan Ghomrawi, Ph.D., M.P.H., an associate professor of surgery at Northwestern University Feinberg School of Medicine in Chicago, has some guidance. His work, “Examining Timeliness of Total Knee Replacement Among Patients with Knee Osteoarthritis in the U.S.: Results from the OAI and MOST Longitudinal Cohorts,” appears in the January 13, 2020 edition of The Journal of Bone and Joint Surgery. “We already knew that the timing of surgery for knee osteoarthritis…
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Junctional Injuries On and Off the Battlefield
By Elizabeth Hofheinz, M.P.H., M.Ed., March 13, 2020 You don’t have to be in a war zone to experience a junctional injury, an event involving the root of an extremity and the adjacent torso to include the shoulder and thoracic outlet or the pelvis, lower part of the abdomen, and proximal part of the thigh.1 Captain Dana C. Covey, M.D., deployed many times to conflict zones, has been called upon to treat patients with such injuries. Dr. Covey, previously chairman of the Department of Orthopaedic Surgery at Naval Medical Center, San Diego, is now a professor of orthopedic surgery at…
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Philadelphia Eagles Surgeon Talks ACL Grafts, Biologics
by Elizabeth Hofheinz, M.P.H., M.Ed., March 4, 2020 Dr. Christopher Dodson, M.D. Christopher Dodson, M.D., an orthopedic surgeon at The Rothman Orthopaedic Institute, is Head Team Physician for the Philadelphia 76ers and Associate Head Orthopaedic Surgeon for the Philadelphia Eagles. Dr. Dodson, who performs approximately 140 anterior cruciate ligament reconstructions (ACLs) per year, talks about the ongoing debate regarding the optimal graft—and the debate over ACL repair.” “Whether choosing between a patellar tendon from the front of the knee, a hamstring tendon from the back of the thigh, or a donor tissue (allograft), it must be noted that there are downsides to…
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Do Orthopedic Trainees Understand the Clinical Implications of Statistics?
by Elizabeth Hofheinz, M.P.H., M.Ed., February 27, 2020 While box plots and whiskers seem a world away from internal fixation and reaming, they are indeed related. Whether in spine, hip or shoulder, it would be difficult to argue with the notion that many of the articles appearing in the orthopedic literature have vastly improved how surgeons work and how patients live their lives. And yet, there is a gaping hole in the education of orthopedic residents when it comes to comprehending the statistics behind the literature. To determine the extent of this lack, a team of researchers from the University…
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Complications After Initial TKA Spell Problems for Contralateral Knee
by Elizabeth Hofheinz, M.P.H., M.Ed., February 20, 2020 The old adage goes something like, “If you want to know the future, look to the past.” In the case of bilateral total knee arthroplasty (TKA), that means all eyes on the initial operation. Concerned about the 20% of patients who report being dissatisfied after TKA, a team of researchers from the University of California set out to see if complications following an initial TKA increase the risk of the very same issues arising after surgery on the patient’s other knee. Their work, “Staged Bilateral Total Knee Arthroplasty: Increased Risk of Recurring…
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Spine Should Secede From Orthopedics?
by Elizabeth Hofheinz, M.P.H., M.Ed., February 5, 2020 Will spine one day turn its back on ortho? At least one spine surgeon hopes so. “Spine surgery should become its own specialty,” says one veteran spine guru. “It can be a division of its own which reports both to neurosurgery and orthopedic surgery. But the training should be different from those of typical orthopedic and neurosurgeons. Those who are interested in going into spine at the outset of their residency could do one year of neurosurgery and one year of orthopedic surgery followed by three years of spine surgery followed by…
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Venous Thromboembolism: Hold off on Declaring Aspirin the Winner
by Elizabeth Hofheinz, M.P.H., M.Ed., February 12, 2020 In one form or another, chemists through the ages have been experimenting with aspirin. When it comes to rubber stamping this ancient treatment for preventing complications following total hip (THA) and knee (TKA) arthroplasty, however, the experimentation should continue, says at least one hip and knee surgeon. Richard Iorio, M.D. is Chief of the Adult Reconstruction and Total Joint Arthroplasty Service in the Department of Orthopaedic Surgery at Brigham and Women’s Hospital in Boston, Massachusetts. Dr. Iorio told OSN, “There is a long history of debate between the American Academy of Orthopaedic…
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Spine in ASCs: Where are We Headed?
by Elizabeth Hofheinz, M.P.H., M.Ed., January 30, 2020 Will tumbleweeds soon drift through the halls of traditional hospitals, bereft of their normal deluge of orthopedic patients? We’re headed that way, says Alex Vaccaro, M.D., Ph.D., M.B.A., President of Rothman Orthopaedics in Philadelphia, Pennsylvania, tongue in cheek. “What really will happen is that healthier patients will be treated at lower acuity facilities that are safe and less expensive than traditional full-service hospitals. Tertiary care facilities will specialize in more complex patient care such as revision joint arthroplasty, spinal deformity, multiple trauma and musculoskeletal infections.” “Part of the new wave of value-based…
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The Mayo Orthopaedic Genetic Host Variation Lab: Personalized Medicine of the Future?
by Elizabeth Hofheinz, M.P.H., M.Ed., February 4, 2020 Who, by their very genetic makeup, is predisposed to certain orthopedic conditions? This is what Matthew P. Abdel, M.D., Director of the Orthopedic Genetic Host Variation Laboratory at Mayo Clinic in Rochester, Minnesota, is aiming to find out. Dr. Abdel, a Professor of Orthopedic Surgery at Mayo, has been awarded an NIH R01 grant to study arthrofibrosis after total knee arthroplasty. Dr. Abdel, who began this lab while still a resident over a decade ago, told OSN, “While in the oncology field, for example, no two breast cancer patients are treated the…
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Need Spine Surgery? Ask a Gynecologist, Say Insurers
by Elizabeth Hofheinz, M.P.H., M.Ed., January 23, 2020 One spine surgeon is greatly troubled by the current reimbursement melee. And with every approval of a new product it becomes worse, he says. “These are FDA approved products,” he laments, “but so far no one has been able to reign in the insurance companies.” Insurance Companies: “Just live with the pain.” “I have had more than one cervical myelopathy patient denied surgery. In one case, the patient’s spinal cord was compressed, he had undergone three surgeries, the plate had collapsed, and he had a nonunion at two levels. The insurance company’s…
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ABOS Update: Joshua Jacobs, M.D.
by Elizabeth Hofheinz, M.P.H., M.Ed., January 24, 2020 They are the gatekeepers of excellence when it comes to orthopedic surgery. The American Board of Orthopaedic Surgery (ABOS), established in 1934, has matured with the times and is now far past the days when newly minted orthopaedic surgeons had to haul old fashioned paper medical records to Chicago for an oral examination. Joshua Jacobs, M.D. Nowadays, for the candidates who descend on Chicago each year for the ABOS Part II Oral Examination, things are much more streamlined…and getting more so, says Joshua Jacobs, M.D., immediate past chair of the ABOS Oral…
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How One Pitt Lab is Tackling Joint Infection
by Elizabeth Hofheinz, M.P.H., M.Ed., January 16, 2020 Kenneth Urish, M.D., PhD Kenneth Urish, MD, PhD is Associate Medical Director of the Magee Bone and Joint Center and Director of the Arthritis and Arthroplasty Design Laboratory at the University of Pittsburgh. As an adult reconstructive and arthroplasty orthopedic surgeon, Dr. Urish has married his engineering background with his clinical practice in order to solve real-world problems. He told OSN, “The most intractable problem facing joint replacement surgeons is infection. And the largest surgical procedure by volume is hip and knee replacement…alas, the biggest reason they fail is infection.” “To tackle…
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Quality Measurement Needs Quality Improvement: A National Leader’s Thoughts on Moving the Needle
by Elizabeth Hofheinz, M.P.H., M.Ed., January 17, 2020 It is most likely that everyone in the medical field is on board with measuring quality. But what, alas, should be measured? One physician in Chicago has reflected profoundly on this question, so much so that he was asked to advise CMS on the matter. Bala Hota, M.D. is the Chief Analytics Officer at Rush University Medical Center and is a national leader in the field of quality measurement. Dr. Hota, also the Associate Chief Medical Officer and Associate Chief Information Officer at Rush, told OSN, “The jury is out as to…
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Want to Lead Others? Know Thyself
by Elizabeth Hofheinz, M.P.H., M.Ed., January 9, 2020 Have all the best leaders undergone psychotherapy? Perhaps…or at the very least they think like Greg Mundis, M.D., an orthopedic spine surgeon at Scripps Health in San Diego. “I am fond of quoting a master of leadership, John C. Maxwell, who said, “Leadership is influence, nothing more nothing less. Show you can lead a team to victory, and you will have shown you can positively influence your followers and organization.” But how to regularly attain such heights? How to draw forth such actionable wisdom from those you lead? Surgeon, know thyself… “Most…
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A “Pathological Optimist’s View of the Residency Application Process
By Elizabeth Hofheinz, M.P.H., M.Ed., December 27, 2019 One joint preservation surgeon isn’t so interested in residency candidates who have nothing but orthopedic surgery on their minds. “I just interviewed 30 residency applicants today—the excitement and the anxiety were palpable. It is so amazingly difficult to be admitted to a program these days. Numerous applicants are trying to distinguish themselves by taking a year to conduct research prior to applying. Along with radiology and dermatology, orthopedic surgery is the most competitive specialty. I think it’s because the word is out that it is a great field that nicely blends clinical…
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