What Are the Hot Topics for Orthopaedic Surgeons in 2013?

    Earlier this year, Jeffrey S. Fischgrund, MD, Editor-in-Chief of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS), listed what he thinks are the hot topics in bone and joint health for 2013:

    • Advancements of technology to surgically treat complex fractures
    • Surgical site infections
    • Deep vein thrombosis

    That got us thinking: What do orthopaedic surgeons who focus on reconstruction of the hip, knee, and shoulder believe are the hot topics for their subspecialties? We asked a number of leading orthopaedic surgeons to share their thoughts. Here’s what they had to say.

    For Douglas Dennis, MD, Assistant Clinical Professor, University of Colorado Health Sciences Center, Aurora, Colorado, and Adjunct Professor, University of Tennessee, Knoxville, Tennessee, the hottest topic remains metal-on-metal (MoM) hip replacement – specifically, how to follow patients who have these implants.

    “It is critical that these patients be followed regularly due to the problems associated with MoM total hip arthroplasty,” said Dr. Dennis, who is secretary of ICJR and a member of ICJR’s Education Committee.

    “All surgeons must be alerted to the importance of regular follow-up every 1 to 2 years,” he said. “They need to know when to order metal ion levels, when to get MARS MRI, when to operate, and so on. There’s a lot of litigation in this area.”

    His other two hot topics: Is there still a place for hip resurfacing, and if so, who should receive one? And, is there a role for cementless total knee arthroplasty?

    Stefan Kreuzer, MD, MS, from the Memorial Bone and Joint Clinic in Houston, Texas, says robotics is his number one hot topic. “It is clearly the new technology that will be a game changer,” he said.

    He also believes the anterior approach to hip replacement will continue to grow and shift recovery following hip replacement. And, he says, kinematic alignment is an area where new research will help define the limits.

    Ali Oliashirazi, MD, Professor and Chairman of the Department of Orthopaedics at Marshall University Joan C. Edwards School of Medicine in Huntington, West Virginia, agrees with Dr. Kreuzer that the anterior approach to hip replacement is a key area for orthopaedic surgeons to be aware of in 2013.

    Dr. Oliashirazi, a member of ICJR’s Education Committee, cites computer-assisted surgery and uncemented total knee arthroplasty as the other hot topics of the year.

    Shoulder surgeon Jeffrey S. Abrams, MD, Medical Director of Princeton Orthopaedic & Rehabilitation Associates, Princeton, New Jersey, noted three controversial topics in his field right now, with good points on both sides of the debate.

    “Should we do open surgical stabilization in high-risk, young athletes, ie, open Bankart?” asked Dr. Abrams, who is also Chief of Shoulder Surgery for SportsMedicine Princeton and Attending Surgeon, Department of Surgery, at the University Medical Center at Princeton. “New studies show a higher-than-expected recurrence rate in teens undergoing arthroscopic stabilization, even without bone loss,” he said.

    He also wonders whether the international community has the right idea in performing stabilization via corocoid transfer (Latarjet) in collision athletes. Orthopaedic surgeons in the United States are more likely to favor soft tissue repair.

    Finally, he said there is debate over treatment of older patients with rotator cuff tears who are failing rehabilitation. Should they undergo a reverse total shoulder arthroplasty, versus surgical repair of the torn cuff?

    Raj Sinha, MD, PhD, an orthopedic surgeon with Star Orthopaedics of La Quinta, California, and a member of ICJR’s Education Committee, looked at practice issues that will affect orthopaedic surgeons this year. His three most pressing issues are:

    • Government claw-back audits
    • Medicare regulations to limit total joint replacement
    • Hospital employment of physicians, which we recently covered here.