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Article Category: Highlights

Advancements in orthopedic care

Table of experts

Republished Content: Atlanta Business Chronicle

Published on April 12, 2024

Last updated 11:04 AM April 15, 2024

Wellstar and the Atlanta Business Chronicle discuss the changing landscape of orthopedic care.

This article was originally published on Atlanta Business Chronicle on April 12, 2024.

Orthopedic care has evolved from injury treatment and corrective surgery into a critical component of modern healthcare. As primary care remains foundational in managing overall health, the demand for orthopedic services has surged, reflecting changing lifestyles, demographics and expectations. In any given year, 12% to 14% of the adult population will visit their physician for back pain, according to the United States Bone and Joint Initiative (USBJI).

Against this backdrop of widespread musculoskeletal issues, Wellstar recently convened with the Atlanta Business Chronicle for a panel discussion to delve into the changing landscape of orthopedic care. This insightful forum explored key trends, challenges and innovations shaping the field, with leading healthcare professionals offering valuable perspectives. These discussions unraveled the complexities of orthopedic care, ranging from preventive strategies to cutting-edge treatments. Among the panelists was Steve Quehl, a former college football player for Notre Dame, who started as a tight end before transitioning to a center. Other panelists were Dr. Hodari Brooks, orthopedic surgeon, Wellstar Health System; Dr. Joseph Burns, chief musculoskeletal officer, Wellstar Health System; Dr. Timothy Oswald, pediatric orthopedic surgeon, Wellstar Pediatric Orthopedics. Moderator was David Rubinger, market president and publisher, Atlanta Business Chronicle.

 


Panelist photo: Steve Quehl, a former college football player for Notre Dame; Dr. Hodari Brooks, orthopedic surgeon, Wellstar Health System; Dr. Joseph Burns, chief musculoskeletal officer, Wellstar Health System; Dr. Timothy Oswald, pediatric orthopedic surgeon, Wellstar Pediatric Orthopedics; David Rubinger, moderator, market president and publisher, Atlanta Business Chronicle

 

The rise of orthopedics and interventions

David Rubinger:  There’s an uptick in the demand for orthopedic services and these specialists have become increasingly essential to healthcare. What societal changes drive this heightened need for specialized ortho care?

Dr. Joseph Burns: We’re facing an aging population alongside a growing desire for an active, pain-free lifestyle. In the past, individuals had to endure their limitations and pain for life. Today, people have more options. Technology, techniques and training advancements now provide surgical alternatives that significantly enhance quality of life well beyond middle age. 

Wellstar conducts numerous community campaigns through various channels, including community events, the media and in our offices and hospitals, highlighting the value of maintaining health and establishing a relationship with a primary care physician.

Dr. Hodari Brooks: Societal changes for both our youth as well as adults have resulted in the increased need for orthopedic care. Physical activity has decreased, with fewer kids participating in physical education. This leads to more injuries related to obesity and lack of activity. The need for joint replacements is soaring, driven by both baby boomers aging and younger individuals seeking treatment earlier. Half of my practice is caring for patients under 55, a shift from when people would wait years for treatment. Now, we prioritize improving quality of life sooner rather than later.

Patients, including those seeking joint replacements, are opting for earlier interventions. They are less inclined to wait for treatment, indicating a shift within the healthcare system towards promptly addressing patient needs.

Rubinger: What new injury trends are emerging in sports due to changing physical activity patterns, especially with the rise of extreme sports and diverse workout routines?

Dr. Burns: The rise in overuse injuries among our younger population is disheartening. Young athletes don’t diversify their sports as they once did, leading to year-round specialization and an increased risk of injury. This relentless pursuit of success often comes at the cost of rest and diversity in physical activities.

We’re also encountering complex medical issues that require specialized treatment, reflecting both advancements in medical care and the aging population’s evolving healthcare needs. Conditions once considered untreatable are now within our reach, marking a significant shift in the scope of orthopedic care over the years.

Rubinger: Dr. Oswald, as a pediatric orthopedic specialist, have you frequently observed the concept of subspecialization and the decline in diversification among young athletes?

Dr. Timothy Oswald: It’s a significant area of concern for us, and we’re conducting more research. Recent studies have highlighted the insufficient breaks and rest periods given to children, as well as the trend of starting high-level athletics too young, which aligns with the issue of subspecialization. Kids are not miniature adults. Their orthopedic stresses differ due to growth plates and differing stress responses.

We’re educating the community, including coaches and parents, about the importance of rest periods during training through channels like social media. We aim to implement better training methods so young athletes can continue playing into their college years, as we’re noticing a concerning trend where many high-level athletes quit sports as early as eighth grade.

Rubinger: Steve, as a former college athlete yourself, what’s your observation of the sports world’s changes regarding how injuries are approached, especially compared to when we were younger?

Steve Quehl:
 I view this issue through the lens of my grandchildren and their friends, and I agree with the insights shared by these doctors. Their perspectives must influence parents’ decisions, particularly regarding the early specialization trend. Parents often have unrealistic expectations of their children becoming professional athletes, which can lead to overtraining and injuries. Kids should have a balanced approach to sports. I’m grateful my daughters chose activities like swimming over contact sports for their children, considering the risks to growing bones and muscles.

Prior to my enrollment at Notre Dame, I appreciated the joy of playing multiple sports during each season for fun, without the pressure of turning it into a professional pursuit.

 

Efficient outpatient care benefits

Rubinger: I’ve noticed remarkable changes in my lifetime regarding the duration of procedures and the efficiency of hospital stays or visits to outpatient surgery centers. I’m curious about your perspective on this shift away from extended hospital stays. Do you believe it’s ultimately beneficial or detrimental to patients? What are your thoughts on this evolution of the time spent in hospitals or surgery centers?

Dr. Brooks: There’s been a significant shift in the duration of hospital stays, especially concerning joint procedures. In the past, patients would typically spend several days in the hospital before and after surgery. In my practice, around 90% of primary joint patients can return home the same day, which is remarkable. This change is not only due to patient preferences for quicker recovery but also has medical benefits, such as reducing the risk of infection. Outpatient joint replacement is not done everywhere, however, and it is important to discuss this option with your individual surgeon.

Insurance companies have started incentivizing shorter hospital stays. While this trend has clear advantages, it also comes with challenges, such as pressure to discharge patients quickly. The ability to expedite recovery and minimize specific complications is a positive development I believe will continue.

Rubinger: Do we have data showing a decrease in complications due to the trend of shorter hospital stays, particularly for joint procedures?

Dr. Burns: Evidence indicates improved outcomes for outpatient procedures, with data supporting this trend. The shift involves a comprehensive approach beyond simply performing the surgery and discharging the patient. It requires a multidisciplinary effort, with investments in establishing preoperative optimization programs, patient education classes and a coordinated team approach on the day of surgery.

Patients undergo physical therapy before returning home, but the care doesn’t stop there. We must ensure effective pain management, minimize infection risks and create a safe home environment to support their recovery. This process goes beyond safely discharging patients. It’s about ensuring their complete and safe recovery. I’m proud of the extensive teamwork and complex processes that Wellstar has implemented to support these programs.

Quehl: When it was time to correct my right shoulder this past year, I went in the morning and came back home in the evening. Dr. Burns assured me that I’d be home the same day, and it was a wonderful experience. I didn’t want any overnight stays. It was well-planned and executed, with proper anticipation and expectations set. The follow-up was excellent, too.

Dr. Brooks: Patients are shocked or hesitant when I inform them that they’ll go home the same day. It’s about managing expectations and explaining the benefits, especially as it relates to improved outcomes. Involvement in these programs gives physicians more control over the process. It’s a serious undertaking but rewarding because we can provide more input, especially in an outpatient setting. Collaboration with anesthesia colleagues has improved, particularly with techniques like regional blocks, as patients need to be up and about after surgery. Almost universally in my experience, patients prefer their outpatient surgical experience to any previous hospital stays.

Multimodal pain management success

Rubinger: This leads me to my next question regarding opioids and pharmacology. Has pharmacology evolved over the last decade to improve patient treatment?

Dr. Burns: Most of us are employing what we refer to as multimodal pain control, which involves a process aimed at sparing, if not entirely eliminating, the need for opioids as a primary method of pain management. By utilizing different medications that target distinct pain receptors, we can effectively manage pain while minimizing potential side effects that may arise from relying solely on opioids or multiple doses of the same medication. Advancements in regional blocks, administered by anesthesiologists, allow injections that can provide numbing effects in the affected areas for several days, alleviating initial post-operative pain and reducing patients’ overall need for pain medication over time.

Dr. Oswald: The opioid crisis in the greater Atlanta area is a significant concern for both children and adults, and it’s something we’re all acutely aware of. We’ve initiated extensive research efforts at Wellstar to address this issue and lead advancements in pain management that don’t rely on narcotics. Similar to the approach described in the total joint experience, we’ve been observing this trend for some time now, even in pediatric cases.

When I trained for pediatric spine surgery 20 years ago, patients stayed in the hospital for at least a week post-surgery. By implementing multimodal approaches, we’ve managed to reduce narcotic use by nearly 90% while also transitioning from a week-long hospital stay to just a 23-hour observation period for certain procedures.

Patient satisfaction is higher with these approaches, directly correlating with their overall experience. Are we expediting discharge solely for the sake of pushing people out? Actually, no. It’s about ensuring patients feel empowered in their recovery process, with their pain managed effectively, and their ability to return to the quality of life they desire. These patient-centered care programs optimize outcomes and enhance the overall healthcare experience.

As regenerative medicine techniques continue to evolve, integrating them seamlessly into our practice holds great potential for improving patient outcomes.

- Dr. Hodari Brooks, Orthopedic Surgeon, Wellstar Orthopedics & Sports Medicine

Innovations shaping the future

Rubinger: What advancements are coming down the pipe in orthopedics? What discussions are medical professionals having about upcoming technologies and innovations? Which aspects of these developments do you believe will enhance the success and satisfaction of your patients?

Dr. Brooks: Regarding joint-related advancements, we’re striving for implants that can withstand the test of time, ideally lasting a patient’s entire lifetime, especially for younger individuals facing conditions like juvenile rheumatoid arthritis. We’re not quite there yet due to the wear and tear on joints, but ongoing improvements in implant technology offer hope for achieving this goal.

The emergence of devices and substitutes to enhance surgical procedures is promising, particularly for challenging cases where additional support is needed for healing. As regenerative medicine techniques continue to evolve, integrating them seamlessly into our practice holds great potential for improving patient outcomes. Advancements in surgical techniques are crucial for minimizing procedure duration and ensuring efficient and effective treatments for patients.

Dr. Burns: The future of orthopedic surgery is very exciting and promising. We have minimally invasive techniques that are constantly being developed to reduce trauma and scarring. An exciting technological advancement is 3D printing, and we continue to utilize it to create customized implants, braces and prosthetics for our patients. Last week, we used a 3D-printed shoulder implant for a patient with a severe deformity, and it fit perfectly.

We have robotics and navigation systems that help us enhance our precision during surgeries and improve the accuracy of implant placement. There’s also biologics and regenerative medicine. We are doing a significant amount of research on stem cells to advance the ability of physicians to use the patient’s own bodies to help improve their situations.

We use virtual and augmented reality in the operating room, which is helpful for pre-surgical planning or intraoperative guidance. Artificial intelligence (AI) is everywhere, and orthopedics is no exception. We now use AI-powered algorithms to improve our research and decision-making, removing a lot of the bias that we know can negatively affect our decisions.

In the future, our success hinges on embracing new technologies, advancing surgical training and education, prioritizing safety and ensuring cost-effectiveness. Many of us find the blend of expertise and technological innovation exciting.

 

Workforce and wellness

Rubinger: A big industry issue is finding enough healthcare professionals, technicians and staff. How does that impact the orthopedic field specifically? Is there less of a supply issue, or are you facing the same problems?

Dr. Oswald: The data shows that there will be a shortage of orthopedic surgeons nationally by 2026, affecting more rural communities first and then metro areas. When you break it down into subspecialty areas, even within pediatric orthopedics, there is going to be a huge shortage of pediatric orthopedists within the next five years. Wellstar is investing in education for the next generation.

With the Wellstar Kennestone orthopedic residency and the recent affiliation with the Medical College of Georgia, we are training over 40 orthopedic residents annually, an important pipeline for the future of Georgia and the training programs. How they communicate and integrate future technology will be critical to managing operative and nonoperative patients.

Rubinger: What is your perspective on workplace trends and what businesses should do to prevent their employees from needing orthopedic care regularly?

Dr. Brooks: We’re observing a positive trend where many employers are beginning to offer financial incentives to their employees. They say, “If you quit smoking or participate in our wellness program, we’ll lower your insurance premiums.” This approach has tangible effects because a decrease in premiums is significant for individuals.

Employers are increasingly providing workplace exercise opportunities and addressing concerns like ergonomics. Carpal tunnel, a common workplace issue, has decreased with the introduction of appropriate desks and keyboards, impacting employee health.

We serve as the gateway for patients returning to work. Employees who are our patients interact with us, wanting to return to work within a few weeks post-surgery. We consider not only the surgery but also the work environment. Employers offering light-duty options or sedentary tasks facilitate quicker returns to work for patients. The recovery process may take longer if the only option is full-time work.

Dr. Burns: If employers proactively work to prevent orthopedic injuries or detect them early by offering resources and support, they’ll be more successful in maintaining a healthy and productive workforce. Playing catch-up when injuries become more complicated due to a lack of ergonomic assessments, education, breaks or a safety culture is detrimental. The culture within a company plays a significant role. There will be consequences if it promotes pushing employees to exhaustion or injury. Business owners need to be proactive.

Rubinger: Has working from home been both positive and negative? Have you seen this either help or hurt in terms of your patients?

Dr. Brooks: There’s not enough research in this area to give a definitive assessment, but I’ve observed younger individuals feel the need to work from home several days a week. The concern arises from whether this trend will lead to a sedentary lifestyle, as physical activity tends to decrease when you’re not commuting to work or engaging in office tasks. This shift will likely increase soft tissue injuries like quadriceps, patellar and Achilles tendon sprains and tears among the weekend warrior types who become less active during the week.

Dr. Oswald: We’re witnessing a surge in overuse injuries linked to technology and social media. This issue isn’t directly tied to the workplace but to where our children receive their education. They spend hours sitting in school, then continue to sit at home using their laptops and iPhones, leading to forward-leaning posture and subsequent back pain. Back pain associated with technology has become the most frequent complaint in our clinics. It’s a genuine concern and presents an opportunity for us to tackle it head-on.

Rubinger: Steve, what advice do you give your family members from someone who’s had to go through full shoulder replacement? And what kind of advice do you give them regarding their physical health?

Quehl: Physical and mental well-being are intertwined as the doctors have highlighted. It comes down to instilling discipline in our daily routines. Start with simple tasks like making your bed, then engage in physical activities like going to the gym or pool. Limiting screen time, especially for children, is crucial, and parents should monitor this closely. Nothing can replace the benefits of stimulating brain activity through physical play outdoors. How often do kids climb trees, play in the yard, or enjoy games like tag compared to spending time glued to their screens? Sometimes, it might be necessary to take away the phones and allow them to rediscover the joys of being kids.

Rubinger: What are the best strategies for individuals regarding engaging with an orthopedic practice and caring for their bodies? You mentioned physical therapy and preventive measures. What other advice do you have for people to avoid needing to visit your office as much as possible?

Dr. Burns: Like many areas, our greater Atlanta population has a mix of individuals who are bright, educated and very health conscious as well as a group that, for various unfortunate reasons, has given up on their health.

For both of these groups, moderation is the key. Everyone should invest in maintaining a healthy lifestyle, but that can mean something different to different people. In order to stay healthy, extremely active people may need to moderate their activities down as they age, whereas inactive people may need to safely ramp up their activities.

Regular exercise, proper nutrition and adequate rest can keep your bones and joints strong and healthy. Periodic checkups with a physical therapist to evaluate flexibility, muscle strength and balance can be helpful to assess musculoskeletal health and detect potential issues early on. In addition, taking preventive measures such as wearing appropriate footwear (newer shoes are better than expensive shoes), using proper techniques learned from a certified trainer or physical therapist and avoiding overexertion can all help people stay out of the surgeon’s office.

It’s always important for people to listen to the cues their bodies are giving them as ignoring pain can lead to further damage. Lastly, be your own best advocate. Follow treatment plans laid out by your physician, communicate effectively with your healthcare providers to be sure they understand your condition and concerns clearly and seek second opinions from specialists if you have any doubts.

As Wellstar specialists in 2024, we believe we should offer subspecialized care tailored to our communities’ needs. This approach begins with prevention and extends to helping patients regain the highest possible quality of life. Achieving this requires collaboration among numerous experts to create a culture prioritizing patient care and delivering a world-class experience from start to finish.

Learn more about ortho care at Wellstar or find a specialist near you.

 

Tags

D Hodari Brooks Timothy Stephen Oswald Joseph P Burns
Self Care Senior Health KidCare Bone and Joint Care
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