Early Warning Signs of Modular Hip Failures?…EHR spoiling orthopedists workday?…Good Spine Surgeries Getting Bad Name?…Sgaglione New President of AANA…Schon New President of AOFAS…and more.
Good Spine Surgeries Getting Bad Name?
An orthopedic spine surgeon tells OTW, “The success of spine surgery depends significantly on the indication. Unfortunately, we have a certain group of spine surgeons who are doing some surgeries at a higher-than-necessary volume and for unindicated purposes. This means that good surgeries are getting bad names. I have patients coming to me saying, ‘You are my third opinion because the other two doctors say I should have decompression and fusion and I don’t want fusion because I’ve heard it’s bad.’ I tell these patients that they are hearing bad things because some surgeries are being done for the wrong indications and thus the patients don’t do well. And despite studies showing that fusion really works for correct indications, insurers—who are hearing the same negativisms that everyone else hears—are clamping down on the approval of fusion.”
“One of the biggest insurers in our region has ‘gone Draconian’ and will not approve any fusion unless the patient has emergent neurological problems such as bowel and bladder incontinence, and has undergone a long line of conservative care. So what is driving all of this? Well, reimbursement rates are higher for fusion so that is certainly some financial motivation for a more aggressive surgery. If we don’t regulate ourselves and agree on strict surgical indications, ultimately the insurers and the government will do it for us. And at this point, I don’t think there is any coordinated national effort to get spine surgeons to regulate themselves.”
Nicholas A. Sgaglione, M.D. Now President of the AANA
Dr. Nicholas A. Sgaglione, chair of orthopedics at North Shore University Hospital in Manhasset and LIJ Medical Center in New Hyde Park, was recently elected president of the Arthroscopy Association of North America. Dr. Sgaglione, who specializes in sports medicine and joint replacement, also holds the position of chairman and professor of orthopedic surgery at the Hofstra North Shore-LIJ School of Medicine.
Dr. Sgaglione earned his medical degree from the Mount Sinai School of Medicine, and completed his residency in orthopedic surgery at the Hospital for Special Surgery, and a fellowship in sports medicine and arthroscopic surgery from the Southern California Orthopaedic Institute and Southern California Sports Medicine and Orthopaedic Group.
And the Next Wave of Device Failures Will Be…
Ryan Nunley, M.D., assistant professor of orthopedics at Washington University in St. Louis, tells OTW, “While the recent FDA meeting was focused on metal-on-metal articulation at the bearing surface, the next line of metal related issues that we’re beginning to see is with modular metal necks. Traditional total hips were all one piece (monoblock), but more recently some companies have jumped on the modular neck bandwagon. We are seeing corrosion at the location where the modular metal neck snaps into the body of the femoral stem, which is leading to a significant amount of metal ion release.”
“Companies are saying that these necks have been tested and are stable—and yes, they are likely not overly susceptible to fracture anymore. But there is clearly micro motion rubbing at the junction generating the metal debris and causing tissue necrosis and pseudotumor formation. The use of larger diameter heads on these modular necks with the same size trunion might also be causing more micro motion. While a bigger head may be a good thing in some respects for reducing dislocations, the downside is that the larger you make the head the more you increase the torque on the trunion taper, which causes the metal to shear and flake. This could be our next wave of failures with use of modular femoral necks in total hip replacement surgery.”
Patrick F. O’Leary, M.D. Receives Lifetime Achievement Award
Dr. Patrick F. O’Leary, an associate attending spine surgeon and former chief of the Spine Service at Hospital for Special Surgery (HSS), received the Lifetime Achievement Award at the hospital’s 29th Annual Tribute Dinner on Monday, June 18, at the Waldorf Astoria. Dr. Patrick O’Leary has focused on the fundamental principles and evolving techniques of spine surgery over the past 35 years. He specializes in the surgical management of disorders of the cervical, thoracic and lumbar spine, including revision surgery. He helped co-develop the Spine Section in Biomechanics in 1990 and establish the Biomechanics Fellowship at HSS in 1991.
A native of Ireland, Dr. O’Leary attended medical school at the National University of Ireland and then completed a rotating internship at LDS Hospital in Salt Lake City, Utah. Three years of a general surgery residency at Roosevelt Hospital in New York City was followed by a residency in orthopedic surgery at HSS. Dr. O’Leary then traveled north for a spine fellowship, completing his training at the University of Toronto.
Mismanagement Holding Up Residencies
Want or need more residents for a growing program? Be sure and have your act together, says a certain 5th year resident. He tells OTW, “At my institution we have struggled to add residency slots. While this has been good from the existing residents’ perspective—we get to do a lot more surgeries—the fact that the Residency Review Committee keeps turning us down is frustrating. I can understand, however, because I have seen some administrative mismanagement—and I know we’re not the only institution where this is happening. I just returned from a meeting where residents at other facilities told me that they have dedicated administrative faculty so that they can guarantee all of their paperwork is in order…and their program may appear to be in better shape than it truly is.”
EHR: One Size Fits None
An orthopedist with his eye on efficiency tells OTW, “At my institution, as at many, the transition to electronic health records (EHR) has been bumpy from two fronts, the institution and the larger healthcare system. First, from a policy perspective, much of the early meaningful use criteria is not specific to orthopedists…it’s in danger of being a ‘one-size-fits-none’ situation. The information that a primary care doctor needs isn’t typically what an orthopedist would collect. An immunization record, for example, has zero relevance to our work. There is also some angst that we are being made to collect information that doesn’t reflect the quality of what we do. Take this physician quality reporting initiative—antibiotic use in surgery. The surgeon must give the right type of medication, the correct dose, in the correct time period, but there is no evidence that antibiotics even prevent surgical site infection for orthopedic procedures that do not involve implants! But I still have to focus on that metric, utilizing precious resources that could be focused on actually improving quality.”
“EHR are the vehicle for quality reporting allowing policymakers to expand this idea requiring information to be collected at every patient interaction. Don’t get me wrong, transparency and quality are paramount to improving our health care system and if meaningful use and PQRI (The Physician Quality Reporting Initiative) are a true reflection of quality of care then it’s worth the effort. But if not, we run the risk of negatively impacting access to care—if I spend more time and resources collecting data, I may not be able to see as many patients, therefore, limiting my ability to meet the increased demand for musculoskeletal care. On an institutional level the issue is, ‘Can you develop a system that works for everyone?’ It starts with engaging each department and finding out what they need in an EHR. What can this information be used for internally and academically? If we need to increase volume to meet rising demand, is this going to help or hurt those efforts? Additionally, EHRs are yet another force that is encouraging physician/hospital alignment; the systems necessary to meet the new requirements require substantial financial investments, and individual practices may have an extremely hard time handling this requirement themselves.”
Lew C. Schon, M.D. Installed as President of AOFAS
Dr. Lew Schon, director of Foot and Ankle Services and director of the Foot and Ankle Fellowship at Union Memorial Hospital in Baltimore, is the new president of the American Orthopaedic Foot & Ankle Society. Dr. Schon will also serve on the Board of Directors of the Orthopaedic Foot & Ankle Outreach & Education Fund (OEF). Dr. Schon is a two time recipient of the prestigious Roger Mann Award and the J. Leonard Goldner Award.
Dr. Schon is assistant professor of Orthopaedic Surgery at the Johns Hopkins University and clinical associate professor of Orthopaedic Surgery at Georgetown University School of Medicine. Dr. Schon received his medical degree from Albany Medical College in Albany, New York, and did his residency at Hospital for Joint Diseases Orthopaedic Institute in New York. He then completed a foot and ankle fellowship at the University of Texas Health Science Center in Houston. Dr. Schon was an AO Scholar in Foot and Ankle Surgery at the University of Washington/Harborview Medical Center in Seattle.
