Dr. Thomas Byrd

You might think that someone who works with “loose bodies” is a plastic surgeon. In the case of Dr. Thomas Byrd, founder of the Nashville Sports Medicine and Orthopaedic Center, however, the work lies more in the realm of failing hips and knees.

Thomas Byrd was born in Nashville, Tennessee, to a mother whose time was consumed with taking care of six children, all one year apart, along with a father who was a busy general surgeon. “Interestingly, my father rarely gave advice, preferring to lead by example. While a medical career was never my plan, over the years I developed an interest in chemistry and biology, and, not sure which direction to take, went to college. I am now proud to be the third generation of doctors to serve the Nashville community.”

After highlighting many a math and physics textbook during his undergraduate years at the University of Miami, Thomas Byrd set out for medical school. “I entered the Vanderbilt School of Medicine in 1978. In my third year I began clinical rotations and then quickly decided on orthopedics. The hands-on nature of the field was appealing, as was the obvious intellectual stimulation. Not to mention the fact that all the orthopedists I came into contact with were a good bunch of folks who were quite animated.”

Deciding to stay where he could get a hot biscuit on a Sunday morning, Dr. Byrd took up higher level orthopedic study in Kentucky. “I began my residency at the University of Louisville (UL) in 1982. It was a good fit for me to remain in the south, and the Louisville program was known for being very hands-on, something that I knew would accelerate my understanding of orthopedic concepts. ‘Two sides to every coin’ comes to mind when reflecting on that time. While we were given a great deal of autonomy, it was pretty stressful because the challenging problems of patients with no recourse were being thrown at us day and night…often without a lot of supervision.”

“The facility’s greatest strength, ” says Dr. Byrd, “was its trauma program. In fact, UL had a trauma center before there were even level one trauma centers. Helping me navigate these waters was Dr. Walter Badenhausen, an accomplished sports medicine doctor who worked with the University of Louisville athletic programs. A quiet and dignified hand surgeon, Dr. Badenhausen also had a busy pediatric practice. It was amazing to see this Abe Lincoln looking guy enter a room and all of the kids rush up to hug him. Perhaps most impressive was his consistent demeanor. He never assumed a different persona—he was who he was. As for how he influenced my career, Dr. Badenhausen had an extremely unpretentious nature that somehow struck a chord in me. Here was this accomplished surgeon who was able to achieve so much and didn’t have a big ego.”

And in a way, Dr. Byrd’s greatest strength was his father. “Unquestionably, my father was my most significant mentor. In addition to being available for me 24/7, he was an inspiration because of his service to our country, and because of the experiences he endured. As a medical officer in World War II he oversaw ‘Normandy’ and lost 75% of his officers in the first 24 hours. In the course of discussing my trauma experience in general surgery work with him one day, my father said, ‘I saw all the trauma I ever needed to see in the first 24 hours at Normandy beach.’”

Dr. Byrd knew that to become distinguished, one must distinguish oneself. “During my intern year the chief resident landed a sports medicine fellowship with the renowned Dr. Jim Andrews, whose facility sounded like an excellent place for training. After determining that there was little separating me from anyone else looking at such a program, starting in my first summer of residency I took every vacation at Dr. Andrews’ clinic. By the last year of residency I had secured a place in his fellowship program, where I would come into contact with world famous athletes…as well as the lady who bakes pies down the street.”

“Aside from imparting his exceptional surgical skills, Dr. Andrews also taught me that you must treat athletes as regular people. Whenever he walked into a room, whether the patient was a famous athlete or someone who had never been on CNN, at that moment in time that person had his undivided attention. Dr. Andrews may not have taught me every procedure I do, but he graced me with the tools that set the stage for all of my accomplishments.”

A brief sojourn “up East” in 1989 would broaden Dr. Byrd’s thinking as far as how healthcare delivery can be structured. “Because I knew that many people come limping in to see a sports medicine doctor, I spent six months focusing on total joints at New England Baptist Hospital in Boston where I got an opportunity to see how the healthcare system works in a different environment. Boston has more of a traditional educational format with more hierarchy, whereas Birmingham is more geared to private practice—and, even though it’s the south, the wheels of change turned a little faster than in Boston.”

He continues, “I then returned to my Nashvillian roots and went into private practice where I focused on sports medicine and arthroscopy. Like most orthopedists who do arthroscopy and sports medicine, I spent a lot of time on knees and shoulders. As time went on and my desire to do something novel increased, I turned more toward elbow and hip arthroscopy.”

Dr. Byrd’s quest for originality would result in hope for the hopeless. “The area that has set me apart more than anything has been my role in developing techniques for arthroscopic surgery of the hip. In 1990 my partner had a young teenager with loose bodies in his hip, and asked if I would attempt to remove the fragments arthroscopically instead of doing an open surgery. We did so and it worked exceptionally well.”

“Based on that experience we realized that we could remove loose bodies arthroscopically. Things limped along, with one or two such patients a year being referred to me. After awhile, our physical therapist approached me, saying, ‘I think my brother has loose bodies in his hip.’ The imaging didn’t show much, so we considered the possibility that there were radiolucent loose bodies. I did an arthroscopic surgery in the hip, where I found a bucket handle tear of the labrum (a large displaced fragment entrapped in the joint). We removed the fragment and after 14 years this guy’s symptoms were gone. We now knew that there were other things going on in the hip that could be addressed arthroscopically.”

He continues, “We then began receiving a lot of referrals for patients who had been experiencing unexplained hip pain for a prolonged period of time, and for whom conservative treatment had failed. Time and again we went in with an arthroscope and were able to identify the damage in the joint. As we began recognizing these problems, we started to nudge the radiologist to get better at detecting them. It was becoming obvious that most problems went unrecognized and untreated for several years.”

“And keep in mind that the evolution of hip arthroscopy is different than that of knee arthroscopy. With the knee most things we address have evolved from open techniques and gradually evolved to less invasive methods. In the hip, most things that we addressed evolved from no treatment at all. In the past we weren’t doing big open operations on otherwise healthy joints. Most problems in the hip went unrecognized and patients were simply resigned to living within the constraints of their symptoms. Athletes are especially prone to these problems and have many times been forced to give up their careers.”

Dr. Byrd didn’t need an arthroscope to see into the future. He knew that each of these cases—as data points—would one day tell a more complete story. “The two smartest things I ever did were number one, marry my wife, and number two, begin keeping track of this data early on. We now have 16 years of data on approximately 4, 000 patients. There has been a lot of pathology recognized in the last six or seven years that we didn’t recognize existed in the early ‘90s. Prospective data collection doesn’t capture that, obviously. Fortunately we have videos and X-rays on all patients so we can go back and look at data on, for example, impingement, something that was not recognized in the ‘90s. As you can imagine, this is an enormous undertaking.”

Also a visionary in the visualization realm, Dr. Byrd saw room for improvement in the offerings of the day. Not pleased with what was available at the time, in the early ‘90s he developed a technique called the “Supine Approach to Hip Arthroscopy.” Dr. Byrd: “This approach involves positioning the patient in a way that provides adequate joint space for safe access and visualization of the joint. The basic principles we described all those years ago are sound, and thus the original technique has changed very little. As technology has advanced, we’ve built on the basic principles and introduced other methods to access the joint. The basic procedure is to use a distraction device, or a standard fracture table, and apply distraction force to the hip joint and separate the joint surface 8 to 10 millimeters for safe entry. We use three arthroscopic portals for access to the central part of the hip joint, even managing to address pathology surrounding the hip area.”

Even after making these advances in hip arthroscopy, Dr. Byrd knows that there is still work to be done. “I am excited that there is such a groundswell of interest in hip arthroscopy and joint preservation strategies. There are so many talented and innovative people who are turning their attention toward this area. For awhile there were only a handful of us doing this…to the point where we could recite each other’s presentations. Now, there is more understanding of and interest in hip joint pathology. When hip arthroscopy began we didn’t know certain problems existed. Now we are much better poised to dig deeper and determine why these problems exist.”

This devotee of the arthroscope wants his trainees to approach this tool with a dash or two of caution. Dr. Byrd: “When working with visiting fellows, I am mindful that their philosophy and approach is probably pretty well established by the time I begin to work with them. The most important thing I can impart is how to perform these procedures as safely as possible and how to undertake the appropriate patient selection. We know that the results of our procedures are more dependent on proper patient selection than on how successfully you do the procedure.”

“It is essential to ensure the patient has the type of pathology that can be successfully addressed with arthroscopy. For example, someone with advanced arthritis is unlikely to benefit from arthroscopic intervention but may be an excellent candidate for hip replacement. It is also vital to ensure that the patient has reasonable expectations of what the procedure can accomplish. If you have someone whose lifestyle and daily activities have been hindered for years because of hip pathology they may really benefit from arthroscopy but they should understand that they’re not going to return to running marathons.”

Regarding the “first smart thing” Dr. Byrd did, he and his wife Donna are celebrating 30 years of marriage in 2009. “Donna and our two wonderful daughters, Allison and Ellen, have always taken wonderful vacations and enjoy being out on the water. Fishing is always one of my favorite parts of the trip. Actually, for 31 years we have been going to the Caribbean with the same group of boating enthusiasts. We head down, enjoy the crystal blue waters, go free diving, spear fishing, and deep sea fishing. It’s all very relaxing.”

Dr. Thomas Byrd…collecting data, compiling evidence, and rounding up grouper.