Other Articles

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.

What Complaint is Numero Uno in the PearlDiver Database?
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.

Arthroscopic Treatment for Tennis Elbow: Coming on Strong
“Tennis elbow” or lateral epicondylitis is, according to our PearlDiver database, one of the most reported diagnosis for problems with the elbow. Lately clinical evidence has shown that arthroscopic treatment for tennis elbow can provide long-term stability and, in most cases, return of the elbow to its optimal function. Check out the data from PearlDiver.

Do Republicans Make Better Orthopedic Surgeons?
A recent Nature Neuroscience journal study of the decision making differences between liberals and conservatives appears to argue in favor of Republican surgeons! Which, frankly, explains a lot—to BOTH sides and, to stretch an analogy almost to its breaking point, it may also explain why McCain’s health care plan is different from Obama’s. Read OUR take here.

"Sound of Music" Turns to Greek Tragedy for Smith & Nephew
Smith & Nephew’s Swiss (mis)adventure with Plus Orthopaedics is turning into a Greek Tragedy. The company’s whole acquisition strategy is being called into question. Read how CEO Illingworth explained it to the brutal British press.

“Dear John Letter” for Hip Resurfacing?
“Dear John H. Resurfacing: I hope this little note finds you well. We certainly have had some great times and, gosh, I’ll never forget those wonderful moments when the FDA approved your PMA. We’ve just celebrated our second anniversary together and, well, I’m just not feeling the magic anymore….” Two years after FDA approval, how happy are orthopedists with hip resurfacing? Read our analysis here.

In the Beginning, There Was the End: Manuscripts 101
Dr. Paul Manske, Professor of Orthopaedic Surgery at Washington University School of Medicine in St. Louis and Editor-in-Chief of The Journal of Hand Surgery, shares his thoughts and experience on the details of shepherding a manuscript through publication.

Did ConMed Get Re-Wired?
Ever hear about the neurosurgeon who used an $80 Bosch power drill to do brain surgery? It really happened. Surgeons like their power tools. Increasingly they also like a particular line of sterilizeable power tools from ConMed’s Linvatec unit. Did ConMed get re-wired? We have the details here.

On particularly long days, Dr. Joseph “Jody” Buckwalter, Chair of Orthopaedics at the University of Iowa, recalls his completion of an intensive Outward Bound survival course. “It taught me I could continue to work through just about anything,” says Dr. Buckwalter. More later on surviving the woods.

An Iowan by birth, Dr. Buckwalter’s family history at the University of Iowa goes back a number of years. “My father attended medical school at the University of Pennsylvania and was told by faculty there that Iowa had a stellar surgery department. Following this recommendation, in 1946 he went to Iowa, where he met my mother, a medical student who was one of three women in her class. My dad, who was on faculty at Iowa for many years, moved us to England for a year when I was five years old. It was soon after WWII and parts of London were still in shambles, with bombed out buildings and rationing still in effect. I developed an interest in my father’s surgical fellowship. One of the most interesting things I recall was his participation in an operation in which conjoined twins were separated, something very unique at the time. Although my parents were physicians, going into medicine was my decision. They were excellent role models who believed that medicine was a noble profession where you work hard and have satisfying experiences. I find these things to be true every day.”

While studying learning and memory in college, Jody Buckwalter thought he was on track to become a psychiatrist. But other interests would come calling. “I began medical school at the University of Iowa in 1969, but I dropped out for a year to pursue a master’s in pathology. I was fortunate that the Chair of Internal Medicine needed someone to take care of his house in exchange for room and board. I helped out a lot, bartended for his parties, and got to meet many interesting people. He was a master clinician and sparked my interest in internal medicine. When I finished medical school I did one year in internal medicine, but then I was lured into orthopedics by the workings of the musculoskeletal system. The more I saw, the more intrigued I was by the way the integration of different structures and tissues allows us to be mobile. It was also satisfying to be able to give mobility to someone who didn’t have it. There was also something very rewarding about being physically able to correct a deformity or damaged bone or joint.”

Jody Buckwalter’s next big opportunity would be on a molecular level. “I began an orthopedic residency at the University of Iowa in 1975. After two years in residency, I spent a year conducting research on the structure of extracellular matrices and cells in intervertebral discs. My work involved the cell types and changes in cells as they age in the disc, an interest that led to a fascination with proteoglycans. Then I had a rare opportunity. I had been studying the disc matrix structure as a medical student and submitted an abstract to the Orthopaedic Research Society in 1976 and had it accepted. When I attended an ORS meeting, the person moderating the session was the President of the Orthopaedic Research Society, Dr. Larry Rosenberg of New York University (NYU). He had worked on the structure of cartilage proteoglycans and was kind enough to invite me to New York to show me his work. For two weeks I worked with him at NYU and learned these techniques. I then returned to Iowa and finished my residency in 1979.”

For his research on proteoglycans, Dr. Buckwalter would receive the prized Kappa Delta Award. His career launched, he would find a professional home at the University of Iowa. “My early years here brought a variety of clinical opportunities, including hand surgery, trauma, and sports medicine. I also did a significant amount of research with the help of grants. And when our tumor surgeon decided to leave I took over the tumor practice here. A career-changing event occurred in 1999 when I became the department Chair, something that had not been my goal initially. Most important to me was being a clinician and a teacher. It has always been gratifying to help students and residents who are motivated and interested but struggling to understand concepts. I appreciate being able to improve their knowledge and skills and see them gain confidence. In all honesty, they teach me so much. Also important to my professional life is innovation. I enjoy thinking about unsolved problems and trying to figure out new ways to look at them. Then there is the fun of coming up with new ideas to test those new approaches.”

And with a virtuoso as a mentor, Dr. Buckwalter would soon hone his research skills even further. “The legendary Ignacio Ponseti came here to Iowa in 1941 and established an orthopedic biochemistry lab. His philosophy and approach to medicine enlivens my research and practice to this day. Dr. Ponseti believes that understanding basic tissues and how they function, along with cells, matrices, and metabolism, is what leads to great advances in understanding, preventing, and treating disease and injury.”

Detailing his important research, Dr. Buckwalter notes, “Working with a group of scientists, I studied how proteoglycans change with age and disease. We found that large molecules, which are an important part of the matrix of articular cartilage, become smaller and more irregular and less effective as we age. Digging deeper, we then asked why that happens and engaged in experiments over the years to understand that process. We found a decline in the ability of cells to make younger molecules. Again we asked, ‘Why?’ and discovered an alternation in the DNA. The reason for that, we found, was that there was oxidative damage and high mechanical stresses in the DNA. Joints need a certain amount of mechanical stress to stimulate cells to maintain cartilage, but stress exceeding the threshold damages cartilage and leads to degeneration of the joint.”

Continues Dr. Buckwalter, “Our more recent work involves formulating an understanding of why joint injury causes a joint to become osteoarthritic. Thus far our team of surgeons, scientists and bioengineers has found that these injuries involve levels of mechanical stress release mediators, which are matrix fragments or biologically active molecules. These mediators propagate damage after the initial mechanical insult, so we are trying to find ways to halt the negative effects of those mediators.”

Dr. Buckwalter, who has been granted a Zimmer lifetime achievement award, as well as a Shands lifetime achievement award, has seen the landscape of medicine change over the years. Commenting on the generation gap in orthopedics, he notes, “Societies and professions change and new people stimulate the field as they are often more open to different ways of practicing and looking at things. There is a range of people entering the profession who have a variety of interests. I think it is part of the responsibility of the teachers to understand the changes in society and share with up-and-coming orthopedists that the central values of medicine don’t change. It is the methods and tools that change. Sacrifice, commitment, and the ethics of treating patients should not change.”

For all of Dr. Buckwalter’s accomplishments, his most important award is the lifetime achievement that is his family. “My most satisfying experiences have been as a husband and father. My wife and three children have brought me more great memories and joyous moments than anything else. My hobbies include studying history, philosophy, and religion. The kids and I have great adventures, such as short triathlons and long bike rides. And yes, there was the parent-child Outward Bound Northwoods intensive survival course where we didn’t eat for long stretches of time and were challenged to our physical limits. The other participants included a Green Beret and a Navy seal. They swore it was as bad as the military, but that it offered an extra kick in the pants: You had to pay for it! But it taught us all that working as a team you can do pretty much anything you put your mind to.”

Dr. Jody Buckwalter: surviving and thriving in the fields…orthopedic and otherwise.