Other Articles

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.

Rising CMS Orthopedic Payments for 2009
If you treat orthopedic problems in the elderly who have complications and comorbidities, you’re going to like CMS’s proposed payment system for 2009. Read about how to maximize your reimbursements.

Replace or Fuse? Can’t Decide?
An upcoming paper titled “Controversy of Total Ankle Arthroplasty” says the answer should increasingly be “replace.” Certainly as an outpatient procedure and with new technologies like Wright Medical’s new INBONE system, replacement/arthroplasty is on the rise. Using PearlDiver data we map out this very important market.

Implant Retrieval Labs 101
The secret life of…implants? Dr. Joshua Jacobs, Professor and Chairman of Orthopaedic Surgery at Rush University Medical Center in Chicago, discusses the details of implant retrieval labs. Preclinical testing to predict implant performance, studying components when implants are removed, and the value of observing the pathogenesis of the failure at different time points in the process, are examined here.

Where Intuition Meets Intellect: Recruiting Surgeons
Whether locating new talent via colleagues or advertisements, says Dr. Thomas Einhorn, Chairman of Orthopedic Surgery and Professor of Biomedical Engineering at Boston University, one must employ one’s instinct and intellect. Dr. Einhorn talks here of how to interview surgeons, how hiring is related to the payer mix, and red flags.

Biomet Reports Strong Knee and Hip Sales for Third Quarter
Despite going private, Biomet keeps the curtain open to the public. Read about a great third quarter and what the company's CEO had to say about going public again to the locals in Warsaw.

The Rising Spinal Implant Market
“A rising tide lifts all boats.” With more than 30 million physician visits each year for back-related symptoms leading to a million plus spine-related surgical procedures, spine care is a $7.1 billion business. The 800-pound gorilla in this market? It’s still instrumentation and interbody fusion devices. What’s driving spinal implant growth? We use PearlDiver’s massive databases to find the answer.

Stryker’s Double-Digit Revenue Machine
Stryker continues its roll of double-digit revenue growth for the 29th straight quarter. Company skipper Stephen MacMillan gives analysts and investors another lesson about thriving in a challenging economic time. Read about his take on the state of orthopedics.

Match Day…the Next Five Years
On March 20, 2008, auditoriums around the country vibrated with excitement as medical students awaited their fate. Read the final article in our series on Match Day as experienced by two future orthopedists.

AAOS Awards Orthopedics This Week and Hofheinz the MORE Award – Again
For the second year in a row, the American Academy of Orthopaedic Surgeons (AAOS) has awarded its prestigious Media Orthopaedic Reporting Excellence (MORE) Award for journalistic excellence to Orthopedics This Week and senior writer Elizabeth Hofheinz.

Price Increases for Large Joint Implants
According to the patient records in PearlDiver’s database, the average charge for a total knee replacement increased more than 19% from 2004 through June 30, 2007. Hip replacement charges rose 15.7%. That’s an increase of just over $7,500 for a total knee replacement and $6,700 for a total hip in three and a half years. Is this a durable trend? Read on.

The Future of Innovation in Orthopedics Part I: MAKO Surgical
With the Office of Inspector General driving a wedge between surgeon and manufacturer, is the golden age of orthopedic innovation behind us? Could Charnley or Harrington pass muster these days with the OIG, IRB or CMS? This is the first of three articles exploring the future of innovation in orthopedics and we profile one company, MAKO Surgical, that epitomizes, we think, the right way to do it.

DePuy: Taking It to the Streets in ‘08
DePuy’s Group Chair Mike Mahoney met with analysts at the recent AAOS meeting to talk about growth strategies for the franchise. He brought along his chief orthopedic guy, David Floyd. See how the happy warrior and his team plan to take the battle for knees to the streets in 2008.

The Evolving Reimbursement Landscape for Spine Procedures
CMS, AMA, 510(k)…Oi. Cindy Vandenbosch, President of Strategic Reimbursement Consulting talks here about procedure codes, coverage, and the high bar for evidence-based medicine.

Geriatric Orthopedic Surgery – It’s the future, baby!
The number of patients over 65 years of age is increasing 10 times faster than those under 65. Is your practice ready? The average geriatric patient has 1.8x the complications of the non-geriatric patient. Medicare is now paying a small bounty to those surgeons willing to track comorbidities. Read how one orthopedist has made geriatric orthopedics her primary focus.

Chan's Sentence, Industry's Lessons
Dr. Patrick Chan didn't have to go to jail or pay huge fines, but his role as witness for federal prosecutors and the continuing civil lawsuits may affect orthopedic companies for years. Will it change industry and surgeon relationships? Who is still on the hot seat? Read our take here."

How to Start a World-Class Orthopedic Department
Building an orthopedic department means ensuring that you have and can keep the best physicians, can maintain a financially viable entity, and that you know how to collaborate with others. Dr. Richard Gelberman, Chair of Orthopaedics at Washington University School of Medicine in St. Louis, shares his thoughts on this process.

An Exquisite Sense of Exploration
“If I have seen a little further it is by standing on the shoulders of Giants." – Sir Isaac Newton. Sir John Charnley had 300 hip surgery failures—consecutively. The polio epidemic struck down a generation of this country’s children and one future president. It became the heart and soul of modern orthopedics. We pay homage this week to that exquisite sense of exploration and the giants upon whose shoulders we all stand. You must read this.

As both Director of the Minimally Invasive Orthopedic Institute and Grant Medical Center in Columbus, Ohio, and Adjunct Professor of Biomechanical Engineering at the University of Tennessee, Dr. Ray Wasielewski is well positioned to understand how the lab translates to the OR.

Prior to being concerned about bones and loads cells, however, he spent his early years thinking about engineering. “I was born in Schenectady, New York, and was one of six children. I was an active child who did a lot of sports and outdoor recreation. Much of our time was spent hunting and fishing in the Adirondacks far away from civilization. My father was an engineer who worked on jet aircraft engines and gas turbines and taught metallurgy at Rensselaer Polytechnic Institute. My mother worked at keeping six kids fed and only later took time to return to school and get a degree in art. She is now a member of the exclusive Cincinnati Art Society. Having the chance to observe my father’s love of engineering stimulated me to follow in his footsteps.”

But life experience and a career test would point Ray Wasielewski in another direction. “I entered Virginia Polytechnic Institute and State University as an undergraduate in 1977 and stayed on to obtain a master’s of science in materials engineering. During this time my interest in research was peaked, so I went to Oak Ridge, Tennessee, for a summer to work on novel materials. It wasn’t very fulfilling, however, as there were governmental issues that slowed things down. The following summer I interned at General Electric and found out the meaning of ‘messy business.’ One day there had been a union problem and I was assigned to keep an eye on things overnight. We found out the next day that during the night the turbine blades had been damaged on purpose. It made me realize I didn’t like the business of engineering, in particular how the separation between management and union makes it difficult to get along. I returned to school in the fall and took a career test to determine my standout interests and talents. According to the test, right after engineering was medicine. I spent two months volunteering at the ER in Blacksburg, where the doctors let me stitch people up and help in other ways. While GE already had a position for me in their young executives program, I turned it down. When I told my dad there was silence on the other end of the phone line. He eventually got used to the idea, however. I had missed the normal cycle for entry into medical school, so I delved into premed courses and got my master’s in metallurgy, something that would prove valuable for my later work.”

His initiation into the world of medicine would require a mental shift. States Dr. Wasielewski, “I entered medical school at Ohio State in 1982. The first two years were pretty hard because the exams were multiple choice. I was accustomed to graduate engineering school where we had a three-hour open book test with three questions that were all about applying fundamental principles to complex problems. I soon found out that medical school was largely about regurgitating facts. Once I got to clinics and started applying knowledge to problems, however, I did well. I knew I just had to get through and gain that foundation. This was particularly challenging, though, because I hadn’t taken many of the prerequisites. One case during this time affected my career significantly. We had a patient with a fistula in his bowel that required resection. We had taken blood gasses, so after the surgery I plotted out the blood gases and showed that we had missed a spot; the bleeding continued and I alerted the Chief Resident. That was my introduction into the importance of attention to detail. The Chair of the department learned of my work in the case and arranged for me to go to the Pittsburg Presbyterian Hospital for orthopedic residency.”

Dr. Wasielewski would move through the next five years without taking a deep breath. “I began my residency in 1986, an experience that was more rigorous than I expected. For four years I took no vacation and had call mostly every other night. My wife survived by riding horses and working as a pharmacist. We were actually apart for a while, as she stayed in Ohio while our home was being built. I was busy working with wonderful orthopedists like Dr. Harry Rubash, who is now the Chair of Orthopedics at Harvard. An extremely detail-orientated surgeon, he had trained under Bill Harris at Harvard and brought those skills back to Pitt. He taught me to have 100% of my mind focused on the moment, and to get engrossed to the point that I did not even hear things around me. Because of him I learned not to talk when I operate; I just put my hand out for instruments. We wrote manuscripts together and he persuaded me to become an academic orthopedist.”

Other mentors would contribute to Ray Wasielewski’s intellectual development, as well as to his growth as a calm surgeon. “I began my fellowship at Rush-Presbyterian St. Luke’s Medical Center in 1991. I was under the direct tutelage of Dr. Jorge Galante, the inventor of porous coating. Working with the tremendously intellectual Dr. Galante, who thought like a metallurgist, reawakened a desire in me to use my engineering skills in orthopedics. I had always known I would study wear, but now I started to try on an inventor’s hat. Another remarkable person at Rush was master surgeon Dr. Aaron Rosenberg, who I witnessed handle the worst cases with exceptional skill. He would know exactly how long he could be in the case next door before he would move to help me in my room, meaning, of course, that he could readily judge our abilities and knew how much supervision we needed. He also taught me a lot about keeping things in their proper perspective. I remember one night I got a call from the hospital saying that there was a problem clearing a patient for surgery. I worked from 3 a.m. – 6 a.m. to get the patient cleared when Aaron came in the door and could see that I was upset. I told him, ‘I don’t think the patient is cleared,’ to which he replied, ‘Well, if the case is cancelled that is just nature’s way of telling us that we need to go out to lunch this afternoon. How about dim sum!’ After I recovered from the shock I could see this was his way of telling me, ‘Let’s step back a little. Don’t sweat the little stuff.’ Again, a few months after the fellowship I called Aaron because I had a complication where I couldn’t cure a knee infection and was despondent. He said, ‘Is the patient still alive?’ ‘Yes,’ I responded. He then said, ‘Then it’s still just an infected knee. Call me anytime you have a real complication.’ While we doctors want to care about everything we do, it can also be a burden if we are overcome by failure. It would be crippling. I remain forever indebted to Aaron for the invaluable lessons he taught me. They have provided significant guidance to my life as a surgeon and caring healthcare professional.”

Along the way, Dr. Wasielewski has also served patients by working in the lab. “During residency Dr. Rubash and I looked at the anatomy of the acetabulum and found that we could put screws in safely without hitting the nerves and vessels around the pelvis. You can’t see them so it’s important to establish zones for safe screw placement. Our work is in fact the source of the board exam question, ‘What are the safe zones for screw placement in hip replacement?’ I also learned a lot on the research front from Jorge Galante. I worked in his retrieval lab and published papers on wear in joint replacement. We found that patterns of wear on implant retrievals are not totally explained by design. If a certain design fails, you would expect the wear pattern to look the same each time it failed. It made me think about all the things that affect wear patterns that we didn’t understand. This work led me to research on measuring pressures in surgery. I thought that if we could measure this we could prevent abnormal wear and joint failure. Now I am working with Dr. Rick Komistek of the University of Tennessee on technology to improve the ability of surgeons to optimize implant longevity.”

Continues Dr. Wasielewski, “Recently Rick Komistek and I did a study with Depuy on mobile bearing knees. We inserted sensors and measured the pressure in surgery and saw how it correlated postoperatively with function. Many of these patients have lift off, a sign that the joint is not doing what it’s supposed to. Essentially, there should be no separation of the implant. We found that there are certain surgical variations that influence lift off. We tied things we do in surgery to postoperative kinematic findings. It was very exciting because nobody’s ever been able to measure this before. Now we’re creating wireless implants and instruments so that surgeons can see the compartment pressure throughout TKA to improve balance and kinematics.”

And he never forgot his inventor’s hat. Says Dr. Wasielewski, “From 1992-2002 I served as Chair of Joint Reconstructive Surgery and then as acting Chair of Orthopedics at Ohio State. I was inventing and wanted to retain the patents, so I separated from the university. One of my projects involving intellectual property is on an absorbable acetabulum rim that gives temporary stability to the hip. After a replacement the ball sits in the socket and can dislocate. You can put it into a constrained cup, but then the insert constraint is there forever and creates wear. This is a temporary ring that after three to six months dissolves, leaving the cup to function like a normal cup but provides only temporary stability so patients don’t have a long-term problem. Currently when surgeons have to revise a person's hip replacement they often must be lengthened to prevent the hip from dislocating. To address this issue I patented a liner that gives the hip temporary stability until the tissues have healed. Zimmer purchased this patent from me, known as biologically reabsorbable acetabular constraining components.”

Regarding the relationship between industry and doctors, Dr. Wasielewski says, “I think doctors will always have the opportunity to contribute intellectual property to product development. In the past maybe surgeon intellectual property hasn’t been valued as much as other surgical and design considerations. Most of the industry has spent dollars on consulting arrangements with surgeons, as opposed to spending money on relationships that procure their intellectual property. Going forward industry will likely focus on surgeons with IP. And there will be increased competition amongst the companies for people with intellectual property.”

To help prime the pump for inventions, Dr. Wasielewski gets away from it all. “Yes, I do the golfing thing like most surgeons. But I also love fly fishing, something I’ve been doing since the age of 12. Being out in the wilderness with friends and nothing around is just great. My wonderful wife is a pharmacist, our son is a golfer and 2nd degree black belt, and our 12-year-old daughter is an accomplished English equestrian rider since the age of four. We enjoy traveling around the country to watch her compete.”

Dr. Ray Wasielewski…bringing focus and calm to the OR and the lab.