Other Articles

Biologics for Spine: Where We Are Now
Dr. Jeffrey Wang, Chief of the UCLA Spine Service and Director of the UCLA Spine Surgery Fellowship, discusses the exciting happenings in spine biologics, including growth factors, the use of different genes, and injecting stem cells into the disc. And then there are the challenges, namely the disc environment and the funding environment.

Physician Medicare Payments: Grandma vs. Docs
The fight over Medicare physician payments in Congress has been reduced to a fight over limited public dollars between Grandma and her physician. Is this a prelude to how public health care policy will be decided in the future? Read about the tussle here.

Spine Niche! Opportunity in the Spinal Deformity Market
Given the myriad of start-up companies pursuing the same patients, product differentiation and solutions for specific target markets could be the key in the future. Using the PearlDiver Patient Records Database we estimate procedure volumes for posterior fusion as a treatment for scoliosis—followed by the results of a study identifying complications associated with instrumented posterior thoracic fusion in treating scoliosis.

AAOS Political Action Committee
Active players in the orthopedic field know the importance of the AAOS Political Action Committee (PAC). On the cusp of hot topics affecting physicians and patients, the AAOS PAC works diligently to provide data to members of Congress and improve the present and future of orthopedics.

Who ARE These Guys?
Every 60 seconds or so a surgeon tears the cover off an Integra LifeSciences package. Quietly, this company has become the seventh largest medical implant manufacturer serving orthopedic surgeons in the world. Where to now? Would you believe $1 billion in two years? How about $2 billion by 2015?

Redemption in a Mechanism of Failure: The TOPS™ Story
Impliant’s TOPS™ System had a “squeaker” in its clinical study. After a voluntary suspension of the study by the company and finding the mechanism of failure, the FDA has approved a resumption of the study. What insider lessons were learned? Class starts here.

Who is Numero Uno in the PearlDiver Database!! Are You Surprised?
The answer may surprise you. Is it sore backs, aching hips, sore knees, fingers? PearlDiver details 3.8 million spine related complaints—complete with demographic information and charging information. But that’s not #1. PearlDiver also lists 3.5 million large joint complaints. Sorry, still not #1. What could the most common orthopedic complaint possibly be? To get the surprising answer…read on.

What the Knees Need: Baby Boomers and Their Options
Knee patients often show up at the doctor’s office with recurrent mechanical symptoms. It is up to the orthopedist, says Dr. Giles R. Scuderi, Director and orthopedic surgeon with the Insall, Scott & Kelly Institute in Manhattan, to thoroughly assess the patient and then determine if nonoperative treatment will do, or if the person needs a unicompartmental or total knee procedure.

Physician: Report Thyself
The government says its healthcare anti-fraud efforts are working and it wants to encourage physicians to self-report possible fraud. How well did the government do in 2007 and what about those deferred-prosecution deals with undisclosed evidence? Read about it here.

Revising the Statistics
The word that orthopedic patients least want to hear is “revision.” Who, in the universe of large joint patients, do we expect to see on the receiving end of this news? If you guessed “the elderly” you would have been wrong. The reality of who is hearing “revision” may come as a surprise. Read what we found when probing PearlDiver’s database.

Where Is Ben Now? Trends in Venture Capital
What is being funded by VCs and why? First of all, spine is having to share the spotlight, says Gary Stevenson, Managing Partner at MB Venture Partners, LLC. Here Stevenson outlines what constitutes an attractive investment…he also highlights issues that are affecting the distribution of VC funding.

The Hounds of Wall Street
Conventional wisdom on Wall Street is that ArthroCare is in a bare-knuckle fight to the finish with short sellers. Which leaves us with the dominating question: If ArthroCare is essentially a “lame duck” growth stock, then why are sales, earnings, and the stock price contradicting the short seller’s dire predictions and even outperforming consensus analyst forecasts? We have the answer.

The Era of “Tell Me Right Now” Dawns at FDA
The FDA wants the next phase of post-market oversight to change from self reporting to proactive surveillance. How? Through the Sentinel Initiative. Read what it means to device manufacturers here.

The Day After Tomorrow: Complication Rates and Instrumentation Trends in Posterior Lumbar Fusion
Could PearlDiver be the Nostradamus of spinal instrumentation? This most commonly performed surgery on the lumbar region of the spine increases fusion rates and improves spinal stability—but what about complications? Using PearlDiver’s database we find the answers. Are you ready for some quatrains about what happens next?

You Try It. No You Try It First: New Technology Adoption
What are the forces working for and against new technology adoption? Youth versus age, risk taking versus conservatism, and the economic realities of the day, says Dr. Rick Guyer, President of the Texas Back Institute.

Cheaper, Thinner, Faster, Stronger
In this, the second of our series of three articles on innovation, we tackle the question: How do you measure medical technology innovation? While difficult, measuring innovation is NOT impossible. Why? Well to start, and in the immortal words of Supreme Court Justice Potter Stewart, “We know it when we see it.”

SAS Crosses the Rubicon in Miami Beach
The SAS 8th Annual Global Symposium in Miami Beach may have crossed the Rubicon. How? Read about the Society’s opportunities for growth and collaboration as its new President lays out a vision for the future.

Between the hipness of Ben Casey and the bedside manner of Dr. Kildare, Joseph Zuckerman could not resist the allure of medicine. Smiles Dr. Zuckerman, “You could say I decided to become a doctor because of the television show ‘Ben Casey’. With his ‘in charge’ attitude and technical expertise, I couldn’t help think that he was ‘the coolest’. Dr. Kildare had a softer, gentler approach—I thought that as a doctor I could blend both styles.”

Now the Walter A.L. Thompson Professor of Orthopedic Surgery and Chair of the NYU Hospital for Joint Diseases Department of Orthopedic Surgery, Dr. Zuckerman looks back on his early years. “I was born in the Bronx and then at the age of four moved with my family to Long Island. My father was an accountant and my mother was a homemaker who worked part time alongside my dad. My two brothers were nine years older and were twins, thus making me a ‘quasi’ only child. I was an avid basketball player in high school and was drawn to orthopedics because I enjoyed the anatomy of the musculoskeletal system. My sports injuries led me to spend time with orthopedists. I was fascinated with the way they put my casts on and thought, ‘I would love to have a job like this.’”

Following in the family tradition, Joseph Zuckerman entered Cornell University as an undergraduate. “After college, I had a choice of staying in New York, essentially the comfortable option, or going west to Wisconsin,” says Dr. Zuckerman. “Sensing that I needed to experience a different part of the country, I chose to enroll at the Medical College of Wisconsin in 1978. I ended up loving Milwaukee and had a great time while there. Because I had fractured my wrist in my senior year of college and needed surgery the summer before medical school, I began medical school sporting a cast. My first four months I labored away with a cast on, including during anatomy dissections. In medical school I found Dr. Paul Jacobs, a fellow New Yorker who had done his residency at the Hospital for Joint Diseases (HJD). He provided follow-up care for my wrist and introduced me to HJD.”

In 1978 Joseph Zuckerman picked up stakes and headed further west to the University of Washington in Seattle. “The program at UW was fantastic, truly cutting edge. Dr. Victor Frankel was the chair of the Department and as it turns out was another HJD graduate. After three years he moved to become chair at the Hospital for Joint Diseases, where he ultimately recruited me back. While in Seattle I worked with Dr. Rick Matsen, now chair of the orthopedic department. A shoulder expert, Rick was highly supportive of my developing a career in that area. Bob Winquist was our trauma expert and an outstanding teacher and surgeon who imparted wonderful information on how to care for patients.”

Along the way, Dr. Zuckerman found his voice. “As a fourth-year resident, I wrote a historical review of the treatment of femoral neck fractures. It won a department award and I presented it at our annual lectureship. I discovered a love of presenting, as well as a fondness for knowing so much about one topic. From then on, I could see myself conducting research and presenting the findings. When I presented the femoral neck fracture paper I did so to our visiting professor, Dr. Clement Sledge, at the time chair at Brigham and Women’s Hospital in Boston. Later that year when I interviewed for a fellowship in adult reconstruction surgery and arthritis research, I interviewed with Dr. Sledge. A consummate academic orthopedist who excelled in basic science and clinical research, he became a significant role model for me. He was an excellent surgeon who became a national leader in orthopedic surgery and was ultimately president of the American Academy of Orthopaedic Surgeons.”

From 1983 to 1984 Dr. Zuckerman undertook a clinical and research fellowship in arthritis surgery at Brigham and Women's Hospital and Harvard Medical School. With a budding interest in the shoulder, he then entered a visiting clinician program in shoulder surgery at the Mayo Clinic. “Working alongside Dr. Robert Cofield, one of the preeminent shoulder surgeons in the world, was an unforgettable experience. For a month I was in the OR and clinic with him every day. We developed a close working relationship that continued after I finished the program. As a matter of fact, I feel that many of my career opportunities arose because of the relationships I have developed in this field.”

Dr. Zuckerman, past president of the American Shoulder and Elbow Society, is pleased to see the increased focus on this important subspecialty. “Shoulder and elbow are now two of the most popular areas of orthopedic surgery. Over the past 10 to 15 years, there has been significant growth in technology and the ability to do a wide range of procedures that weren’t done previously. The American Shoulder and Elbow Society was formed 25 years ago by 20 individuals specializing in the shoulder and elbow. Now there are multiple international societies with thousands of members.”

And those surgeons have been busy. Says Dr. Zuckerman, “In the past few years we have seen the development of anatomic shoulder replacements, the reverse shoulder replacement, and different technologies for fracture fixation. We now have an array of arthroscopic surgeries that have largely replaced many open procedures. The shoulder is a complex joint and the simple ball and socket joint replacement design that was initially used didn’t take into account its anatomic subtleties. The newer generation of implants allows surgeons to reproduce the anatomy for each individual patient. The addition of eccentricity of the humeral head and methods to optimize the radial mismatch of the articulation has made an important impact on outcomes. Five years ago I started working with Exactech to design a shoulder arthroplasty system that provided improved methods to reproduce the anatomy. Along with Tom Wright of the University of Florida and Pierre-Henri Flurin of Bordeaux, France, we developed the Equinoxe system. I am very pleased and proud to say that the Equinoxe has been in use now for over three years and the results are confirming that we have been able to design a system that further enhances the surgeon’s ability to reproduce anatomy. Our design and recent release of the Equinoxe reverse arthroplasty system extends these principles to the rotator cuff deficient shoulder and provides a system that does not require removal of the humeral component to convert to a reverse implant.”

Also interested in hip fractures, Dr. Zuckerman has spent much of his career bringing these issues to his colleagues. “I had just completed my arthritis fellowship and visiting clinician program in 1984 when Dr. Frankel said to me, ‘You should study hip fractures in the elderly.’ I couldn’t imagine why at the time, but he felt strongly that this was a growing area of concern within orthopedics. I trusted my mentor’s judgment and watched as history unfolded: Dr. Frankel indeed predicted how important geriatric orthopedics would be, especially hip fractures. Over time we were able to make great steps in defining the problem and improving our treatment of this challenging patient population. We wrote more than 50 articles and texts and tried to shine a light on the issues. It was interesting to see how things changed. In the late 1980s we submitted abstracts and saw them rejected. Ten years later the journals were asking us to write review articles based upon the credibility we had established.”

A hip fracture in a young person is one thing ... for an older person, it’s a double whammy. “When an elderly person fractures a hip, there are a myriad of issues at play,” cautions Dr. Zuckerman. “Mobility is an issue, of course, but then also, 20% of geriatric hip fracture patients may not be alive at the end of the first year. These patients are often in poor health at the time of the fracture. As a result of the fracture, they can’t walk as well and are confined to the home. There are practical matters such as who will do the shopping for them. And there is often an element of depression that emerges. Our mantra about geriatric hip fracture patients was always, ‘They are complex medical, surgical, and psychosocial problems.’ For 15 years we had a multidisciplinary program of nutritionists, social workers, and geriatricians. I am proud to say that our clinical research in this area was recognized in 2002 by the Orthopaedic Research and Education Foundation when Dr. Kenneth Koval and I received the clinical research award.”

Dr. Zuckerman has also been very active as a member of the American Academy of Orthopaedic Surgeons (AAOS). He served as a member-at-large of the Board of Directors in 1992-93. Following that he was a member and chair of different committees. From 1999-2005 he served as chair of the Council on Education and in this position was responsible for coordinating all educational activities. Earlier this year he was elected Second Vice-President of the AAOS and will serve as its President in 2009-10. “My activities with the AAOS have always been very important to me. It is the organization that represents the 25,000 orthopedic surgeons in this country. This is a very important responsibility and I am very proud to have the opportunity to serve in a leadership position.”

He is also proud of his family. “In 1984 I married a wonderful woman named Janet. A clinical psychologist, she has been my steadfast partner in raising two terrific children. One of our sons is a senior at Cornell and is applying to medical school. Our younger son is a freshman at Yale. Until they graduated from high school I made it a priority to attend their athletic and school events. Now that they are launched into the world, I look forward to spending a lot of time with my wife.”

Dr. Zuckerman’s final thoughts? “I consider being an orthopedic surgeon to be an honor and a privilege. One of my most important and satisfying activities over the past 23 years has been the training of our residents. They are among the best and brightest graduates of our medical schools and in many ways they teach us as much as we teach them. In a time when physicians and health care face significant challenges there is one common thread that has not changed. Each and every day we provide care for patients in an effort to make them better. As orthopedic surgeons we can have a profound impact on our patients' quality of life; that is something we should always focus on. It has been and continues to be the most satisfying part of what I do. I always tell my residents that we have been given an opportunity to do something very powerful, namely, to help others. This is the essence of being a physician—it is even more profound in orthopedics. As for me it is something I will always respect and cherish.”

Dr. Joseph Zuckerman ... expanding the field and extending himself.