Changes in Orthopedics

Two weeks ago, the American Academy of Orthopedic Surgeons (AAOS) held its annual meeting in San Francisco. The meeting brings orthopedic surgeons from around the world together for a week of education, exchange of ideas, and camaraderie.  

Physicians, like many other professionals, must continually renew their base of knowledge and update it as the field evolves. While not every technological advance outperforms the current standard, medicine is advancing at a rapid pace. It is important for physicians to remain current in their field. I am inspired and humbled by the collection of thinkers and innovators that this meeting brings together.  

In my lifetime, orthopedics has changed completely. When my older brother tore his ACL, surgical reconstruction was not recommended. He continued to have difficulties that ultimately cut short his collegiate wrestling career. Armed with that historical perspective and with the latest reconstructive techniques, a non-operative approach in the young, athletic population is not common today. Likewise, the shoulder techniques I learned during my training were cutting-edge just a few short years ago. As a shoulder fellow, I published a description of an advanced arthroscopic technique to help solve very unstable shoulders. At this year’s meeting, I saw several posters, presentations, and papers about that technique.

That is not to say that all of the advances in orthopedics have come recently. Some of the fracture techniques we still use are based on principles that have been around for decades or more, and all of today’s advances rest on the bedrock of sound orthopedic principles.

The point is that it is meetings like this one force us all to re-evaluate what we are doing. The opportunity to discuss and debate the merits of new techniques makes us all better doctors. I am grateful for the opportunity to reaffirm and challenge my knowledge base and participate in the community of orthopedic surgeons.

– Robert J Purchase, MD

What’s New

Our annual meeting of the American Academy of Orthopedic Surgeons (AAOS) was this week in San Francisco.  This meeting brings together almost 30,000 orthopedic surgeons, vendors, and sales people to provide intense education on the “latest and greatest” new technology as well as provide ongoing education for orthopedic surgeons.  It is usually quite a show, taking over all three Moscone Convention Center, with exhibits showing the greatest new plates, screws, biologic materials to help tendon healing, bone graft substitutes, instruments to make our surgeries go more easily, and techniques to implant them. 

One of the reasons I love orthopedic surgery is because there is always something new to learn, innovation has been fostered and through this innovation has brought total knee replacements, total hip replacements, and surgeries to improve the quality of life for millions of Americans.  Today, I am actually taking the day “off” from the Academy and spending time sifting through  what I have been learning and integrating that into some self assessment examinations.  (Yes, at my age, I still have to take tests and questions). 

In the next few blogs, I am going to talk about some of the updates that we learned during this meeting. 

Today, I will just say a few words about smoking.  As you know, smoking is no longer as big an issue that we see in California since laws have restricted ones ability to smoke in most public places and even near public buildings.  So, smoking is much less prevalent here in California, and especially in Bay Area.  So, most of us do not think it as a big issue.

However, it is well established that smoking increases risks of bones not healing (called nonunions), failure of fusions of spine surgery, poor wound healing and increased infections in joint replacement, rotator cuff repair, and has a huge impact on healing.  Many orthopedic surgeons refuse to operate on a patient for a spinal fusion or a cervical spine fusion if they are smokers.  I insist my patients that are smokers to stop before I will perform rotator cuff repair since it has been established that there are higher incidences of failure of healing of these tendons.  In my next blog, I am going to speak about osteoporosis and some of the new controversies surrounding that.  This is one of the current “hot topics” in orthopedics.  So, stay tuned in the next few weeks.

– Lesley J. Anderson, MD