Web Platform Connects Surgeons With Fellow Trainees // New Study: Low Volume Surgeons Doing Most Reverse Shoulders // and More!

Second Opinion Network of Superstars Alums…Online

You trained with some superstars…ever wonder what they would do in a difficult clinical situation? Thanks to an unusual web platform, that is now possible. Greg Chang, Cofounder and CEO of for[MD], Inc., told OTW, “When a surgeon can consult with someone he or she trained with then there’s a higher level of comfort with their feedback. Allowing residents, fellows, faculty, and alumnae to connect by specialty or subspecialty furthers clinical excellence. Our platform, for[MD], is essentially a peer-level second opinion network.”

“Take a case that was recently posted. A foot and ankle surgeon who belongs to an alumnae association posted a case involving a young, morbidly obese patient with flatfoot. The person was in pain and had failed nonoperative treatment. This physician, who was a few years post fellowship, wanted feedback and utilized for[MD] to target only fellowship alumni and the mentors he trained under. The opinions of these individuals helped the surgeon provide better care.”

Chang, formerly the Associate Director at Duke Orthopaedics, adds, “We have a critical mass of doctors and medical societies who are sharing vital information; we are now up to 90 organizations, including training programs, alumni associations, and medical societies. I’m proud to say that at this time one-fourth of all U.S. orthopedic surgeons are actively using our platform.”

“Our goal for the next year is to expand our presence in other specialties. We have just begun working with the American Society of Neuroradiology (5, 500 doctors). Eventually we want to be able to connect related specialties together, such as orthopedic spine and neuroradiology.”

Surena Namdari, M.D., cofounder of Collaborative Approaches to Shoulder and Elbow Surgery [CASES] and an attending at the Rothman Institute, told OTW, “for[MD] has allowed CASES members to quickly seek and get informed feedback from other shoulder and elbow specialists. We use the network almost daily to think through the most complicated issues in our field and solve problems quicker. We are also investigating methods to utilize this platform for collaborative research.”

New Study Finds Low Volume Surgeons Doing Most Reverse Shoulder Arthroplasties

Reverse shoulder arthroplasty—a procedure aimed at treating complex problems—is being done primarily by relatively low volume surgeons. The research was led by Judd Day, Ph.D. at Exponent, Inc., and Gerald Williams, M.D. and Joseph A. Abboud, M.D., both shoulder surgeons at the Rothman Institute (at Thomas Jefferson University). Dr. Abboud tells OTW, “We used the Medicare database, which allowed us to see 100% of the sample of patients for 2011, the first year that utilization data for reverse shoulder arthroplasty was made available. In making comparisons between standard shoulder arthroplasty and reverse shoulder we found that a total of 31, 000 shoulder replacements were performed; 37% were reverses, 42% were standard arthroplasty, and 21% were hemiarthroplasty. We did find it surprising that reverse shoulder arthroplasty utilization was almost one to one with standard shoulder arthroplasty.”

“We examined utilization patterns and found a that significant percentage of these arthroplasties are done by lower volume surgeons (those doing less than 10 per year). We found that these surgeons performed 65% of the total shoulders and 57% of the reverses. A full 70% of reverses were done by surgeons who were doing more reverses than standard total shoulders and hemiarthroplasties combined! This is concerning since reverse shoulder arthroplasty isn’t so simple…it is designed for complex cases.”

“My advice to my colleagues is to be careful with the surgical indications, avoid overutilization of reverse arthroplasty, and ensure that you have had advanced training before doing either procedure. Some people feel like a reverse is easier; perhaps because the surgeon thinks that he or she has to be less careful with management of the soft tissue, i.e., the rotator cuff. It is a semiconstrained prosthesis so it pops in and thus has the allure that it is potentially more stable. This might be an oversimplification of the situation, however. While the 5-10 year outcomes data on reverse shoulder arthroplasty is encouraging, there are still significant concerns for complications with this operation. In the United States we have just ‘celebrated’ our 10 year anniversary for FDA approval of reverse shoulder arthroplasty and we continue to analyze our 5-10 year outcomes data.”

“We will be examining the 2012 data to see if the trends continue to increase (reverse over primary); we will also be looking at the breakdown of cases by surgeons.”

Rocky Tuan, M.D. Receives Distinguished Research Award From Pitt

Rocky Tuan, M.D., Distinguished Professor of Orthopaedic Surgery and the Director of the Cellular and Molecular Engineering Lab at the University of Pittsburgh, has been selected to receive the 2015 Chancellor’s Distinguished Research Award, Senior Scholar category. This award honors Dr. Tuan as a faculty member with an outstanding and continuing record of research and scholarly activity. Dr. Tuan’s nomination was supported by many of his colleagues and peers and the selection committee was impressed by his career achievements. Awardees receive a cash prize as well as a grant to support their teaching and research.

Dr. Tuan is a Distinguished Professor of Orthopaedic Surgery and the Director of the Cellular and Molecular Engineering Lab. He is also the executive vice chairman for Orthopaedic Research and serves as the Arthur J. Rooney, Sr. Chair Professor in Sports Medicine. He is the associate director of the McGowan Institute for Regenerative Medicine and the director for the Center for Military Research. He also holds a secondary appointment as a professor within the Department of Bioengineering.

Dr. Tuan told OTW, “It is always most gratifying when one is recognized by one’s family; in this case, the University of Pittsburgh academic family. Particularly gratifying is that the award recognizes not only the research achievements in my laboratory, but also my contributions towards enhancing the development of collaborative research programs on campus that focus on military medicine, focused on bringing therapeutic solutions to battlefield injuries.”

He added, “I am most interested in developing regenerative therapies that will repair and restore musculoskeletal organs and tissues. Current approaches that utilize stem cells, bio-scaffolds are particularly interesting, since they combine biology with engineering. In fact, because of their “cross-over” nature, such research topics are very attractive to students and young scientists, the next generation of researchers.”

Asked what line of research in orthopedics he finds most promising, Dr. Tuan told OTW, “I believe regenerative medicine, which represents convergent science, is the future of medicine, and has high promise of delivering major impacts on the practice of orthopaedics. Instead of the use of inert materials, such as metal and plastic, the future of orthopaedic surgery will entail the application of engineered biological substitutes and tissues to restore function and structure to diseased and injured musculoskeletal organ systems.”

Dr. Freddie Fu, chair of Orthopedics at the University of Pittsburgh, commented to OTW, “Rocky Tuan is the top orthopedic scientist in the world. He worked at the NIH [National Institutes of Health] for ten years before he headed cartilage research at Pitt. Dr. Tuan leads the way in the realm of regenerative medicine. He is very perceptive, his research is superb, and he had a high level of integrity.”