The Unexpected Rise of Hip Revisions and How to Handle Them // Notes from Sochi Olympics U.S. Team’s CMO // and More!
Elizabeth Hofheinz, M.P.H., M.Ed. • Thu, March 20th, 2014
Explosion of Hip Revisions: How to Handle Them
There is at least one doctor at Hospital for Special Surgery (HSS) who is righting an increasing number of surgical wrongs. Geoffrey H. Westrich, M.D. is Research Director of the Adult Reconstruction and Joint Replacement Service at HSS. Dr. Westrich has found himself being sought after for hip revisions, doing several per month on patients who fly in from all across the country. He told OTW, “I’ve just published an article in Arthroplasty on how to approach recalled hip replacements. The original idea was to allow surgeons to intraoperatively do more customization of hip replacements. We traditionally put in a stem which includes a neck; the only modularity we had before that was with the head. The newer designs allowed a modular neck that allowed surgeons to put in a stem and then put in a neck (with a choice of many different lengths and angles). It also came in neutral, anteverted, or retroverted. This allowed us to place the stem in a way that accommodates the patient’s anatomy; it also allows us to intraoperatively select a neck that gave us the best chance of restoring leg length offset.”
“The greatest risk is that of dislocation, which can happen if you don’t restore offset. At HSS we had four surgeons doing this surgery with a dislocation rate of 1.2%. After modular neck prostheses initially came out, fractures of the metal neck (at the neck-stem junction) were reported.”
“Manufacturers switched to cobalt chromium, and although testing revealed no fractures, along came a new failure mechanism no one had ever seen—corrosion. This corrosion led to adverse local tissue reactions and elevated cobalt levels in the blood. The latter brings on systemic cobalt toxicity that causes problems like cardiomyopathy, renal problems, hair loss, rashes, etc. I’ve had patients showing up in my office with their teeth falling out because of this. Unfortunately, the manufacturers sold a lot of these implants before they realized it was a problem. My office constantly get calls from patients and even attorneys whose clients need to have the stem removed. This has greatly increased the amount of revision surgery that I am seeing on a monthly basis, not just for recall hip prostheses, but also for more revisions for other reasons as well.”
“To best care for patients with these recalled hips, surgeons should make sure that their patients return to the office for follow up. Many doctors will say, ‘Oh, I haven’t heard from the patient so everything must be alright.’ But this is an insidious process and not everyone has bad pain that brings them into the office, and if the problem lingers there could be major tissue damage that can result in a very poor outcome in spite of revision surgery. Also, you must always check the blood work to assess metal ion levels. Third, you should use a high resolution metal artifact reduction sequence (MARS), a special MRI for metal suppression to rule out an adverse local tissue reaction. This can show us in the earlier stages if the person has an adverse tissue reaction; at the end stage it will show any destruction of the abductor muscles.”
Notes From Sochi Olympics U.S. Team’s CMO
When Gloria Beim, M.D. founder of Alpine Orthopaedics, Sports Medicine & Regional Hand Center in Crested Butte, Colorado, started college at the age of 14 she could hardly imagine where her life would lead. Recently, Dr. Beim, chief medical officer (CMO) for the U.S. Olympic Team at the Sochi games, found herself staring down a mountain looking out at the Black Sea in the distance. Dr. Beim tells OTW, “There are no words to describe how thrilling this experience was. For eight months I studied Russian intensively, something which wasn’t required of me, but that paid off immensely. Not only was it wonderful to be able to make those human connections, but it was downright practical. For example, it helped me get athletes get through the doping control stations seamlessly. In the village polyclinics—places set up at every Olympic games—I befriended the doctors, nurses, techs and volunteers with my Russian speaking, which resulted in incredibly good service when getting an athlete through X-ray or other medical services. It was also handy when using the pharmacy as all of the packaging was in Cyrillic letters. If you couldn't read Russian, you would have no idea what medication they just handed you!”
And her Russian got an ‘A’ from a certain higher up. “One day President Putin made a surprise visit to our facility. I wiggled my way through security and introduced myself to him in Russian. I received a great compliment from him…he said that I spoke ’perfect Russian.’”
“Our sports medicine clinic was specially built for Team USA athletes and staff. We brought our own diagnostic tools, including diagnostic ultrasound. We had a pharmacy, great recovery services, massage, physical therapy, sports chiropractors, etc. That way, when the athletes would walk into the sports medicine clinic they would feel right at home. The Russians set up clinics—known as a ‘polyclinic’—because a lot of countries don’t bring along their own medical services and they did supply radiology equipment in addition to specialists in many fields including cardiology, ENT, dentistry, etc. The challenges are that the language is different, as is the practice of medicine. If we needed a CT/MRI then we took the athlete to a polyclinic, but we read the films and treated our own athletes.”
“We treated ACL tears, shoulder dislocations, lacerations from ice hockey, and much more. Here is a really important message to my colleagues. When I was the CMO for the Pan American games in 2011 I got my first taste of a diagnostic musculoskeletal ultrasound. Although I had never been a big believer in this tool, I was blown away by its utility. The minute I returned to the U.S. I bought a machine, trained aggressively, and three years later I can’t practice imagine practicing without one. It’s much less expensive than an MRI, patients love it, and you have immediate results…three minutes! These are not just for traveling orthopedic surgeons.”
“Being the chief medical officer for the Olympics was definitely a life changing and amazing experience. I also had the unique fortune of marching in the Opening Ceremonies. What an honor to be part of such energy and excitement.”
Freddie Fu, M.D. Receives Elizabeth Winston Lanier Award
Freddie Fu, M.D. has received the Elizabeth Winston Lanier Award for his career contribution to anterior cruciate ligament (ACL) reconstruction and advances in patient care. This honor comes from the Kappa Delta Society along with the Orthopaedic Research and Education Foundation, and was presented to Dr. Fu in New Orleans at the 2014 Annual Meeting of the American Academy of Orthopaedic Surgeons.
Dr. Fu, the David Silver Professor and Chairman of the University of Pittsburgh Department of Orthopaedic Surgery and founder of the UPMC Center for Sports Medicine, also will receive honors in Europe and Asia over the next four months. This includes an award being bestowed in Hiroshima, Japan, in July from the Japanese Orthopaedic Society of Knee, Arthroscopy and Sports Medicine (JOSKAS). Dr. Fu will be only the fourth surgeon—and second from the Western Hemisphere—recognized with the Masaki Watanabe Award for international achievement in arthroscopic surgery.
NASS Launches New Career Center
NASS has launched a targeted career center where job seekers can home in on spine-specific resources. Katie Szymaksi, sr. manager of Membership Services, told OTW, “In our ongoing attempts to help members further their spine careers, we realized that we needed greater attention to the area of practice management resources. Additionally, in the past several years, the online ‘career center’ market has changed drastically. Individuals are moving from searching for new positions through sites like Monster and are placing a greater emphasis on LinkedIn and other non-traditional sites to look for career opportunities. Through the new NASS Career Center, we are able to not only provide traditional job board functions, but are also able to capitalize on those newer social media resources; the new NASS Career Center is able to integrate on multiple formats, ensuring that our members and potential employers are able to connect.”
“In mid-February, we launched a new website at www.spine.org which includes several features that will allow members to more easily find the information that they’re looking for—including resources for career enhancement. That being said, it can be a challenge to launch a new website at the same time as we are looking to launch this new resource. Many of the features that are included in the new NASS Career Center have not yet been rolled out, including widgets on our social media pages and NASS home page as well as others.”
“Not only will the NASS Career Center be the go-to place for spine care providers and employers to connect exclusively about career opportunities in spine, but the site also goes beyond the “Monster” job search format to ensure that our members can both passively and actively keep an eye on job opportunities that they may be interested in. NASS Career Center users can also add their CV to a resume bank that allows them to anonymously be contacted by employers. Members also have exclusive access to new jobs for three days after posting, giving them an edge from other job seekers.”
“Another key feature to the new NASS Career Center, which is provided as a partnership between NASS and JobTarget, is a career fair that will be held in conjunction with our Annual Meeting in San Francisco this November.”