Surgeon Voice
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Senior Surgeons’ Advice to Young Surgeons
by Elizabeth Hofheinz, M.P.H., M.Ed., December 31, 2019 Much like the timeless advice in Robert Fulghum’s book, All I Really Need to Know I Learned in Kindergarten, much of the wisdom that young surgeons need already lies inside of them. But in case they need a few reminders, here are some appetizing tidbits from those who have inhabited the role of orthopedic surgeons for thousands of days. Alan Daniels, M.D. an orthopedic spine surgeon and Chief of the Adult Spinal Deformity Service at the Warren Alpert Medical School of Brown University in Providence, Rhode Island, commented to OSN, “The best…
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Young, Arthritic Shoulders…New Shoulder Options on the Rise
by Elizabeth Hofheinz, M.P.H., M.Ed., January 3, 2020 It’s a good day to have a shoulder problem. Options of yesteryear were limited. Indeed, 3,000 years ago the Egyptians left hieroglyphs for us depicting a (presumably limited and painful) leverage method of shoulder reduction.1 Kevin Farmer, M.D. is an orthopedic surgeon at the University of Florida (UF) and is team physician for the UF Athletic Association. “We are seeing a rise in shoulder preservation techniques among patients under 40, something that I predict will continue to gain popularity in 2020. These surgeries span subspecialties as they involve managing or replacing joints…
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Drowning in Residency Applications: Surgeon Sound Off
by Elizabeth Hofheinz, M.P.H., M.Ed., December 13, 2019 You’ve heard of throwing the spaghetti at the wall and seeing what sticks. These days, says Wayne Moschetti, M.D., M.S., Section Chief, Division of Adult Reconstructive Surgery and Assistant Professor at the Geisel School of Medicine at Dartmouth in Hanover, New Hampshire, for applicants it’s a bit of, “let’s throw residency applications at EVERY residency and see what sticks.” Dr. Moschetti told OSN, “Orthopedic surgery has become so competitive that it seems many medical students are applying to every program. Our program only has four residency slots per year, but we are flooded with 600-700 applications. Obviously, this creates…
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Only Four in the World…and Pitt Has One
by Elizabeth Hofheinz, M.P.H., M.Ed., December 18, 2019 Question? Who has a deep-dive machine that can give you real-time 3D images of how the shoulder moves kinematically? Only a few facilities in the world—including the University of Pittsburgh Orthopaedic Biodynamics Lab, which publishes more orthopaedic research using this technology than all of the other facilities combined. This unusual tool allows researchers to closely and precisely examine the symphony of movement patterns in the shoulder. Albert Lin, M.D. Albert Lin, M.D., Associate Professor and Associate Chief of the Division of Sports Medicine at The University of Pittsburgh, is a shoulder expert…
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Alan Hilibrand, M.D. on the AAOS Strategic Plan
by Elizabeth Hofheinz, M.P.H., M.Ed., December 12, 2019 Alan Hilibrand, M.D., M.B.A Alan Hilibrand, M.D., M.B.A., vice chairman of academic affairs and faculty development for the Department of Orthopaedic Surgery at the Rothman Orthopaedic Institute in Philadelphia, is also the Treasurer of the American Academy of Orthopaedic Surgery (AAOS). According to Dr. Hilibrand, the Joseph and Marie Field professor of spinal surgery, and professor of orthopaedic surgery and neurological surgery at the Rothman Institute and the Sidney Kimmel Medical College of Thomas Jefferson University, the latest AAOS strategic plan involves three parts. Our first goal is to improve the member…
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Kill the Robots?
by Elizabeth Hofheinz, M.P.H., M.Ed., December 19, 2019 If tech is sexy then robots should be wearing garter belts. But, says one total joint surgeon…look away. “Although robotics are the hottest and latest thing, they are primarily industry-driven. There is little to no science to support their use in hip and knee replacement, and the majority if not all of the evidence supporting its benefits are from surgeons with industry bias. We have almost no data indicating that there is any benefit to surgeons or patients—it is all theoretical benefits at this point in time and driven solely by marketing.…
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Alex Vaccaro, M.D. on Patient Expectations
by Elizabeth Hofheinz, M.P.H., M.Ed., December 5, 2019 Sometimes, reality is overrated. If you are a 47-year old with chronic back pain, then you are really looking for a new reality. And in comes the highly recommended spine surgeon in the authoritative-looking white coat who is going to solve everything. But there is a downside to the traditional reverence that patients have for their physicians. Having cared for thousands of patients, Alex Vaccaro, M.D., Ph.D., M.B.A., president of the Rothman Orthopaedic Institute, knows much about the labyrinthine world of patient expectations. How do surgeons get into trouble when it comes…
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It’s the Metastases, Stupid: Tackling Primary and Metastatic Bone Cancer at “Pitt”
by Elizabeth Hofheinz, M.P.H., M.Ed., December 4, 2019 There is the, “hmmm, I wonder” type of curiosity…and then there is the, “I have to know” type of curiosity. It was the latter that sent a young Kurt Weiss, now an M.D. and associate professor of orthopaedic surgery in the Division of Musculoskeletal Oncology at the University of Pittsburgh Medical Center, straight to medical school. Why? Because Kurt Weiss was diagnosed with metastatic osteosarcoma at the age of 15. “The primary tumor was in my right tibia and it had metastasized by the time of my diagnosis,” he told OSN. “I…
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Orthopedic Surgeons: Insist on Private Rooms for TJA Patients!
By Elizabeth Hofheinz, M.P.H., M.Ed., November 27, 2019 While virtually any patient would prefer a private hospital room as opposed to sharing space with someone else during what is typically a stressful time, little data is available on the relationship between the type of room and patient perceptions of their experiences. With many orthopedic surgeons seeking ways to improve the experience of total joint patients—and given the reality that reimbursement is linked to quality metrics, a team of researchers from the Department of Orthopedic Surgery at NYU Langone Health, NYU Langone Orthopedic Hospital set out to use the Hospital Consumer…
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Use the DASH to Evaluate Upper Extremity Involvement in Cervical Spine Surgery?
by Elizabeth Hofheinz, M.P.H., M.Ed., November 29, 2019 How does a 30-item patient reported outcome measure—the Disabilities of the Arm, Shoulder, and Hand (DASH)—compare to the Visual Analog Scale (VAS) for pain, and neck disability index (NDI) in patients undergoing cervical spine surgery? New research on this topic, “Validation of the Disabilities of the Arm, Shoulder, and Hand in Patients Undergoing Cervical Spine Surgery,” appears in the December 1, 2019 edition of Spine. Co-author Wilson Z. Ray, M.D., Associate Professor of Neurological and Orthopedic Surgery and Vice Chair in the Division of Neurosurgery, told OSN, “I take care of both peripheral nerve injury…
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Bad to the Cervical Bone: ACDF, Depression and Anxiety
by Elizabeth Hofheinz, M.P.H., M.Ed., November 21, 2019 Pain, even the emotional kind, can be felt deep down in the bones. But how does such pain—depression and anxiety—factor into spine surgery? Recent work has tackled this issue, looking specifically at the role of preoperative mental health in postoperative outcomes in patients undergoing anterior cervical discectomy and fusion (ACDF). Andrew Harris, a research fellow at the Johns Hopkins Hospital Department of Orthopaedic Spine Surgery, worked alongside Richard L. Skolasky, Jr., M.A., Sc.D., director of the Spine Outcomes Research Center at Johns Hopkins and employed a retrospective analysis of the Truven Health…
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Dubousset Functional Test: An Objective Test to Assess Function and Balance in Spine Patients
by Elizabeth Hofheinz, M.P.H., M.Ed., November 21, 2019 Things—and people—can come crashing down when they are disabled with a spinal pathology. Famed French orthopedic surgeon Jean Dubousset, who introduced the “cone of balance,” knew this well and developed a straightforward test to determine a patient’s functional capacity. Recent multicenter work published in Clinical Orthopaedics and Related Research, “The Dubousset Functional Test is a Novel Assessment of Physical Function and Balance,” aimed to go beyond the typical quality-of-life questionnaires used to assess functioning and coordination in spine patients. Co-author Bassel Diebo, M.D. is an orthopaedic surgery resident at the Department of…
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Michael Ciccotti, MD Talks Shifting Winds in Sports Medicine Education
by Elizabeth Hofheinz, M.P.H., M.Ed., November 7, 2019 “The tree that does not bend with the wind will be broken by the wind.” – Mandarin Chinese proverb A hallmark of a talented leader is bending with the winds of change. And these days, in the field of orthopedic sports medicine, the winds are indeed shifting. Michael G. Ciccotti, M.D., Director of the Sports Medicine Team at the Rothman Orthopaedic Institute and Director of the Sports Medicine Fellowship at Thomas Jefferson University, has discerned that change is afoot and is working with, rather than against, that reality. “In a traditional learning…
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Dissatisfied Patients=Surgeons Sent for Counseling?
by Elizabeth Hofheinz, M.P.H., M.Ed., November 6, 2019 There’s nothing that says, “Power to the People” like the chance to speak ill of a physician in the online universe. “I am keeping an eye on this trend of rating physicians online,” notes one spine surgeon. “While certainly useful for selecting a restaurant or hotel, these sites are giving carte blanche to disgruntled patients, who may or may not have a legitimate complaint about a doctor.” “These ratings are now a regular part of medicine and at some institutions online complaints have risen to actionable issues. Because reimbursement is tied to…
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Social Determinants of Health: Who Will Fill the Gap?
by Elizabeth Hofheinz, M.P.H., M.Ed., November 1, 2019 “Take your medication and follow up with me in two weeks” seems like a straightforward physician recommendation. But what if the medication is too expensive for this patient? What if she has no one to drive her to see you in two weeks? Many physicians—as well as hospital administrators—might think, “That’s not my bailiwick. I can’t do EVERYTHING.” Think again…and think about this: According to a recent survey by Kaiser Permanente: 93% of Americans feel that their medical provider should ask about access to food and balanced meals; 83% feel that their…
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