OTW has embarked on a mission to highlight promising up-and-coming orthopedic surgeons…those whose contributions rise above and beyond the vital day-to-day patient care to benefit colleagues and, ultimately, orthopedic care more broadly.
Our inaugural “up and comer” is Chris Joyce, M.D., a comparatively new orthopedic surgeon with Colorado Orthopaedics in Lone Tree who is a self-described “math and physics geek.”
As orthopedics is an increasingly data and software driven profession, Dr. Joyce’s “geekiness” is certainly a solid foundation for a future KOL (key opinion leader) to build on.
Typically, math and physics geeks migrate to engineering but, as a junior in college, Dr. Joyce realized that as great as engineering can be, it could not be as fulfilling as a career in medicine. So, then Chris Joyce decided to “Shadow an ER doctor and got a feel for what medicine would entail. I also spent time alongside my dad, a general surgeon. And even though I didn’t shadow any orthopedic surgeons, early on in medical school I decided on this field because my engineering brain knew that it would be a cornucopia of fascinating challenges.”
Dr. Joyce earned his M.D. at the Ohio State University College of Medicine and entered at the University of Colorado, where he was chief resident in 2019. He then began a shoulder and elbow fellowship at Rothman Orthopaedic Institute in Philadelphia, which he completed in August 2020. “I am so grateful for Dr. [Joseph] Abboud, as well as for the mentorship I received from Drs. Surena Namdari and Mark Lazarus, also at Rothman. They did their all to ensure that I was extremely well prepared to meet any clinical challenges that might arise.”
But what no one could teach him was the nuances of building a practice…sometimes it’s just trial by fire.
“Building a practice is indeed stressful and I would advise my junior colleagues to always be available to your patients as well as other providers that ask for help. I recall driving into the ER in the middle of the night several times when the on-call provider couldn’t be reached, which has since helped my reputation and referral base. I also think it is important to take on challenging cases that put you outside your comfort zone early on as this will make you a better surgeon and help build your name. There are times every week that make me feel frustrated or inadequate, but I remind myself to trust my training and always do the right thing for the patient and everything will work out.”
Among the reasons we selected Dr. Joyce is his growing body of research work and growing scientific investigations into shoulder and elbow conditions. His most recent study, “Does early rotator cuff repair improve outcomes in traumatic tears?” has been accepted for publication in the Journal of Shoulder and Elbow Surgery.
Dr. Joyce described his study to OTW, “A small study in 1983 suggested that if you repair a rotator cuff tear within three weeks, then patients fare better as opposed to if you repair it after that time. However, several small patient population studies (30-40 people) have more or less found that there is not much difference if you repair a tear early or later. Most shoulder surgeons will say that you should fix a rotator cuff tear early rather than later, but they do not know a good cutoff time for surgery.”
“For our study, we used the Rothman database and looked at people with rotator cuff tears to determine: 1) if these are truly traumatic injuries, 2) what the mid to long term functional outcomes would be related to the time from the injury to the time of the surgery. We found that indeed patients tended to fare better if the tear was repaired sooner than four months.”
“The clinical implications of our findings are debatable as the differences in scores generally did not meet clinical significance. We are talking about an American Shoulder and Elbow Surgeons score difference of over 10 points. So, while this may not the meet minimally clinically important difference, there was certainly a trend showing that tears repaired earlier had better outcomes than those repaired later.”
“Repairing these tears within the first four weeks is ideal…and we did see that within four months the cutoff scores dipped as well. I am using the results of this study to talk to my patients. If an older person who isn’t especially active comes in with a traumatic injury that occurred a month ago and says, ‘This isn’t really painful. Can I hold off on surgery?’ I will say, ‘Yes, but there is a chance you may have worse function if we wait.’ But if the patient is young and very active it’s probably best if you fix it sooner so that you have better results.”
What are the key clinical issues shaping the future of orthopedics?
“I think we are all going to have to be preoperative and postoperative pain management specialists,” said Dr. Joyce to OTW. “One of the major obstacles to pain management is the patient’s perception of pain control. In Europe the norm is for patients not to receive narcotics after surgery most places. Here in the U.S., however, a typical hip surgery patient would go home with 90 oxycodone not too long ago. Americans’ baseline thought process is, ‘There is always something a doctor can do to make me feel better.’ And that often means narcotics.”
“Nonnarcotic pathways for surgical patients are doable,” says Dr. Joyce, “but it’s an uphill battle because of patient perspectives. And surgeons’ days are so full as it is that we don’t have enough time to counsel them in detail on these matters.”
“Chris Joyce is an excellent surgeon whose technical abilities are far beyond his years,” said Dr. Abboud to OTW. “He also stands out for his understated personality and compassion towards patients. He thinks clearly in the OR, makes good decisions, and executes well. I think that fundamentally, he is a ‘triple threat,’ and will eventually end up in the educational and research arenas as well. He has the ability to be consistently affable, which endears him to his team, which in turn helps them get patients the care they need.”
