On (and Off) the Record

RSA Prevents Certain Revision Surgeries…Best Orthopedic Workplace? Gallup Makes Award…BONESUPPORT Wins Top European Technology Award…Practicing Medicine Where it Really Matters….and more.

New RSA Technique Eliminates Unnecessary Revision Surgery

Wayne G. Paprosky, M.D., a hip and knee surgeon at Midwest Orthopaedics at Rush, knows if you’re implant has been naughty or nice, er, well, if it’s gone a wanderin’…He tells OTW, “Through the use of radiostereometric analysis (RSA) we are having great success at monitoring hip and knee implants; using miniscule beads, we can tell whether an implant has moved to the slightest extent. Since we began in January 2012 we have used RSA in well over 200 patients and have now worked out the ‘bugs.’ For example, we had to adapt the delivery device, and can now shoot the beads in with special guns. We are faster, and the placement of the beads has improved such that we can now do a better job of interpreting the results. Patients are given X-rays the day after surgery, and the scans are sent to Halifax, Nova Scotia, where special computers read the beads.”

“This is going to be very valuable in the next six months when Zimmer comes out with a new cementless knee. There is the likelihood that we will eventually figure out the bead placement for shoulder and ankle surgery as well. Patients think it’s great that we can ‘follow’ them. They know that if in a year and a half they have pain, but the scan shows that their beads have not moved, then they won’t have to have a needless surgery. In the event that they have shifted, then rather than wasting time with pills and tests we can get them to the OR before they lose more bone. Orthopedic surgeons should be cognizant of this option…and certainly whenever they are doing an elective surgery they should use a device that has been tested with these beads. Especially given the metal-metal debacle, there is no way I’m going forward without using RSA.”

HSS Best Orthopedic Work Place Says Gallup

Hospital for Special Surgery has received the 2012 Gallup Great Workplace Award, an honor bestowed on only 27 organizations worldwide this year. The hospital received the award because its results demonstrate one of the most “productive and engaged” workforces in the world. OTW asked HSS President and CEO Louis A. Shapiro the following question: What is the first indication a patient has when he or she enters HSS that “things are different here?” Shapiro told OTW, “It’s not what they see, it’s what they feel! They sense that everyone is on the same page and can easily tell that people really care about the organization and how staff and patients interact. Yes, you would expect the CEO to say that, but truly, it’s validated every day when patients stop me in the elevator, send me ‘thank you’ letters, etc.”

And, says Shapiro, the good feelings are backed up by numbers. “In the first quarter of 2012 our patient satisfaction results said it all: our composite score—which is all questions combined—was in the 99th percentile. To achieve that kind of number everyone in leadership has to feel in their hearts that culture and engagement is important. Then, if you believe it, you have to demonstrate that consistently in your actions. It’s all well and good that I believe it but my actions have to work their way to the front line leadership who at the end of the day create this special environment.”

“The concrete things we do to create this environment include leadership rounds where the executive team sits down with employees and discusses patient safety and opportunities for improvement; there are also breakfast meetings with employees who started 90 days prior. In addition, we have a leadership academy where we invest in the frontline leadership to ensure that they understand employee engagement. The key to any of this being a success, however, is follow up. We make it a habit to follow up on the suggestions of all employees. That is part of the reason why Gallup found us to be an ‘engaged’ workplace. HSS is a place where employees feel responsible for the organization’s success. They sense that they are part of a team, and that their contribution and voice mean something. It may sound clichéd, but we are indeed like a family.”

BONESUPPORT Wins Top Technology Award

BONESUPPORT, a company focused on injectable bone substitutes for orthopedic trauma, bone infections and instrument augmentation related to orthopedic surgery, has been selected as a Top 100 Winner for Red Herring’s 2012 Europe Award, a prestigious list honoring the year’s most promising private technology ventures from the European business region. BONESUPPORT was one of only nine winners within the healthcare categories.

Osteoarthritis (OA): Catching it Early

Carla Scanzello, M.D., Ph.D., is an assistant professor of rheumatology at Rush University Medical Center. She is also the 2012 winner of the Orthopaedic Research Society/Orthopaedic Research Education Foundation Travel Award. Dr. Scanzello tells OTW, “The ORS/OREF award was for my work regarding early-stage knee OA. We discovered that synovial fluid (SF) from early-stage knee OA patients contains a factor that could modulate inflammatory activation of synoviocytes. Since inflammation is variable in OA, the most difficult part is understanding the complexity of what causes one person to develop inflammation versus another. We think this factor may relate to that complexity.”

“To study the impact of inflammation at an early point in the disease—at the point where patients are first at risk—we are following patients who have had a partial meniscectomy because the meniscal tear population is a nice clinical model of patients at risk for knee OA progression. We’re starting to see that individuals who have synovial inflammation are not only more symptomatic at the time of surgery, but over time may develop worse knee symptoms by two years post-surgery. In addition, we are looking at the mechanism of inflammation in these patients, and focusing on immune receptors critical in the initiation phase of inflammation, called Toll-like receptors. Research has shown that a number of molecules produced during cartilage injury can trigger these receptors and lead to inflammation in the joint.”

“One interesting molecule is fibronectin, which is expressed by multiple tissues in the joint…and certain forms of fibronectin may bind these receptors to promote inflammation. So we are exploring the expression patterns of different forms of this molecule which may trigger joint inflammation after an injury like a meniscal tear. We know that many of the patients with meniscal tears will progress to joint replacement…we hope that if we can understand what is causing inflammation then we may be better able to predict who will progress to full blown OA…and can we stop that progression or slow it down by intervening in the initiation phase of inflammation.”

James Caillouette, M.D. Wins Founders’ Award

The California Orthopedic Association has bestowed an honor on Dr. James T. Caillouette, surgeon in chief at Hoag Orthopedic Institute in Irvine, California. He has received the group’sprestigious 2012 Founders’ Award, an honor given once a year to an individual who has exemplified the group’s high standards for leadership in the field of orthopedics. One major accomplishment credited to Dr. Caillouette by the association was his leadership in the merger of two state-of-the-art surgical centers and other entities into Hoag Orthopedic Institute, one of only a few such health care models in the nation.