Joseph P. Iannotti, M.D., Ph.D

He emerged from the Bronx in the 1970s, toughened by the neighborhood yet profoundly influenced by his family’s attempts to find medical treatment for a loved one. Dr. Joseph Iannotti, Chair of the Orthopaedic and Rheumatologic Institute at the Cleveland Clinic and Past President of the American Shoulder and Elbow Surgeons, is a leader whose past is prologue and whose experiences are the source of his exquisite passion and focus.

Dr. Iannotti, who is also Co-Director of the Orthopaedic Research Center, set out early on to do battle with the old stereotype about orthopedists not being the intellectual dignitaries of the research world. But earlier than that, he just had to get through his high school years. Dr. Iannotti: “My parents, who were first generation Italian-American, expected all four of their children to attend college. It was a bit of the Wild West in the Bronx, then, and there were many ‘distractions.’ Yet family—and thoughts of medicine—kept me focused.”

There are two sides to medicine…the giving and the receiving ends. “When I was young, my dad’s sister became paralyzed; despite seeing a multitude of doctors, there was nothing that could be done. After visiting a chiropractor, however, she regained some ambulation. That left a profound effect on my dad, and allowed me to see that families can feel pretty helpless when their loved ones are ill. As for my dad, he went on to become a chiropractor.”

While I can’t point to exactly why I became a physician, I think my dad’s experiences had something to do with it. It certainly wasn’t because I liked sports or was enthralled with the wonders of woodcarving.

It may also have been his dad’s time in the ICU. “My father had peptic ulcer disease for years and at one point nearly died. Because he was in intensive care so long I had lots of time to think about how I could create a life where I might be of service to others.”

After he had done just that, and was ensconced at the Cleveland Clinic, Dr. Iannotti would unfortunately have another personal trial that would deepen his appreciation for the complexities of medicine.

“My son developed a brain tumor at the age of 18 and almost didn’t make it. This taxing time resulted in a sincere appreciation for parents who not only go through enormous personal suffering, but who also must deal with feeling helpless and at the mercy of the healthcare system. I emerged from this time period being much more attuned to families and their struggles. This is the experience in my life that changed me most as a human being.”

During his son’s illness, Dr. Iannotti relied on his unusual ability to temporarily pack things in different boxes. “People tell me that I am exquisitely capable of segmentation, i.e., that I do an amazing job of keeping my professional and personal lives very separate. I honestly don’t know how I accomplish this, but I can put my personal stressors in a box and they don’t come to work with me. When my son was ill I was running a huge department and had just gotten divorced and remarried. It sounds rather callous, so I’m not saying this is something people should necessarily do…but I was able to march on and get my work done without my personal stressors affecting my work time. If I had fallen apart emotionally I would have been of no use to anyone.”

Dr. Iannotti’s inner strength and inner compass have always pointed him in the right direction. “My 20 years at the University of Pennsylvania were incredibly intellectually stimulating. I sharpened my research skills and learned the ins and outs of administration as Head of the Penn Shoulder and Elbow Service. But Penn was also where I had a career failure that changed my life direction. While I was successful in obtaining NIH grants for career development, I was not able to secure an R01 grant at that time in my career. It was an unusual situation in that I was being eyed for the job of Director of the Penn research lab, but alas, I had no R01 funding.”

The maverick in Dr. Iannotti then emerged. He would find his way to the top with a path of his own making. “In 1991 I opted to spend more time training in a subspecialty. When Dr. Paul Lotke said, ‘No one here at Penn is doing shoulder. Why don’t you do that?’ I replied, ‘Shoulder is a respectable joint.’ Knowing that a national reputation isn’t built via surgical skills alone, and having already completed a Ph.D. at Penn, I felt confident that I could craft an academic career in shoulder surgery without formal fellowship training. I looked around at the gaps in the literature, asking myself, ‘What can someone with no clinical practice and no patients do?’ I decided on studying anatomic issues and in 1992 published a paper on the glenohumeral relationships that are related to joint replacement, a piece that has become an often cited reference paper for many of the modern joint replacement designs. I also managed to write the first peer reviewed paper in the orthopedic literature on MRI for diagnosis of rotator cuff tears (published in the Journal of Bone and Joint Surgery). Despite my lack of a formal pedigree, I was admitted to the American Shoulder and Elbow Surgeons in 1992 and was honored to be elected as its President in 2006.”

Perpetually bothered by the old yarn that orthopedists lack intellectual gravitas, Dr. Iannotti has used hard science to turn this stereotype on its head. “It was always bothersome that throughout my training I found the stigma that orthopedic surgeons were not the brightest people in the class, and lacked a real understanding of the sciences. I set out to be the antithesis of that stereotype and earned a Ph.D. in cell biology.”

Dr. Iannotti has used his research skills to bring relief to patients and innovations to market. “In the last ten years I have focused on researching the biomechanics and kinematics of shoulder arthroplasty, something which has resulted in several commercially successful products. I have been particularly proud of our work on computer simulation for arthroplasty of the shoulder and hip and am pleased to see this coming to fruition in the market.”

In mentoring junior surgeons, Dr. Iannotti hopes to teach them to “follow the science—not the money.” “Making a profit should absolutely not be your goal. If you start with a solid research question and follow the science, then you may indeed have commercial success. Take my experience with patient specific instrumentation. Eight years ago this began as a simple research question…we wanted to understand the problem of glenoid bone loss in arthritis and in failed arthroplasty. Our initial question was, ‘What is the internal shape of the normal glenoid bone, and is that shape conserved among normal population, i.e., is there more than one shape and how do they vary?’ Since then we have put forward eight patents around a new technology, and in several months we expect to spin it off as a independent company. The lesson learned was that if you have a good idea that is based on sound science and is clinically relevant—and you stick with it—then it will likely have some commercial value. If, however, you begin by saying, ‘I want to invent something that is going to make me wealthy’ then you will be off track from the beginning.”

Mentoring is so important to Dr. Iannotti that when asked about his most significant career accomplishment he says, “It is the fact that I have helped the careers of about 12 extremely talented people in the orthopedic world. When working with young surgeons, I am careful to explain the necessity of asking meaningful research questions.”

I have seen young orthopedists, eager to answer a question posed by a senior surgeon, hurry off and try to find a solution by undertaking a study. I counsel them to pause and ensure that the question is not only worth their time and effort, but that they have the tools to answer it well. After all, there are only so many research questions that can be addressed in one’s career.

One question that was worthy of Dr. Iannotti’s time was, “What do we know about the pathogenesis of rotator cuff tears—and based on the literature, what do we know about the treatments and their efficacy?” “I served on the AAOS [American Academy of Orthopaedic Surgeons] Task Force for Evidence Based Medicine on Rotator Cuff Tears for a year. This is the most common condition that shoulder surgeons treat on a daily basis…it was sobering to find that there is so much more to be learned. We found that when you apply scientific methods and select the literature based on quality of evidence that things are considerably behind where we would like them to be. Of the 30 questions that we proposed there was only one or two that had enough evidence to reach a conclusion.”

Dr. Iannotti, who says that he never thought he would accomplish so much in his life, perhaps did so because of a simple internal drive. “I am not the smartest guy in the world and a lot people work hard but I have an intense passion for what I do—thus, it really doesn’t seem like work.”

Having a great friend and talented partner also made Dr. Iannotti’s career stimulating and successful. “Dr. Gerry Williams and I have a long standing relationship of collegiality and hard work; we each accomplished significantly more at Penn as a team than either one of us would have accomplished separately.”

“Although I adore my work, I should really try to work a bit less and ‘smell the roses, ’ says Dr. Iannotti. “The problem is that I just don’t have a hobby…so I just keep working. My wife alternates between being supportive and tolerant of my work obsession.”

Dr. Joseph Iannotti…following the science and improving it along the way.