VCU Medical School News

By Nirav K. Patel, MD FRCS

It has been a great year for Orthopaedics from a research perspective, with a heavy emphasis on outpatient arthroplasty, patient optimization and enhanced recovery after surgery (ERAS) at meetings and in the journals. Similarly, Orthopaedics at VCU Health, which continues to provide high quality, evidence-based, patient-centered care from the simplest to the most complex patients in the state, has expanded and had exciting new changes. Having just completed my first year in practice here, I was honored and humbled to write a piece for the VOS 2019 winter newsletter. I will provide an overview on some key papers on total hip (THA) and knee (TKA) arthroplasty, the acquisition of Colonial Orthopaedics, our Top Doctors 2019, faculty changes and new efforts improving surgical outcomes.

Total Hip and Knee Arthoplasty Outcomes
I would like to start with two well performed systematic reviews and meta-analyses in the Lancet on THA and TKA outcomes that we should all be aware. For TKA, Evans et al. examined 30 studies with 6490 TKAs and 742 UKAs, and registries with 299291 TKAs and 7714 UKAs. They found that 82% of TKAs last 25 years and 70% of UKAs last 25 years. For THA, the same group examined 44 studies with 13212 THAs, and registries with 215676 THAs. They found that 58% of THAs can expect to last 25 years. These papers provide robust data to facilitate counseling of patients on the likely longevity of these implants, particularly relevant when these are being performed on increasingly younger patients.

Colonial Orthopaedics
In March this year, Colonial Orthopaedics joined MCV Physicians, our physician practice group affiliated with VCU Health. Colonial orthopedics has been providing community based Orthopaedic services in all major sub-specialties since 1981, and they bring a team of 97 staff to join our department. We look forward to collaborating with our new colleagues in improving patient care, in addition to new and improved research and teaching efforts. This move will expand patient access to the high quality network of primary and sub-specialty providers in the Tri-Cities area, in addition to the resources of VCU Health.

Top Docs
We are fortunate to have multiple VCU Health Orthopaedic Surgeons named as top doctor in their relevant subspecialty, as voted by their peers this year. In Pediatric Sports Medicine, Drs. Joanna Horstmann and Victoria G. Kuester at the Children’s Hospital of Richmond at VCU. In Sports Medicine, Drs. Seth Cheatham and Thomas Loughran. In Hand Surgery, Drs. Ilvy Cotterell, Jessica Frankenhoff and Jonathan Isaacs. Finally, in shoulder surgery, Dr. Douglas Boardman; in joint replacement surgery Dr. Greg Golladay; and in spine surgery, Dr. Rick J. Placide. Congratulations again to these physicians for their hard work in providing high quality patient care. They are an inspiration to us all.

New faculty
We are sad to announce that Dr. Raj Mounasamy MD, has left VCU Health to work at the University of Texas. We are grateful to him for treating the most complex trauma patients and teaching our students, residents and fellows over the years. He was well liked by patients and staff alike, and contributed to the hospital in immeasurable ways. Although his departure is a great loss for the hospital, we wish him well with his new job and future endeavors. In other news, the newly expanded Joint Reconstruction Center (JRC) at VCU Health has been given divisional status, under the leadership of Dr. Gregory Golladay MD. We look forward to this autonomy to provide enhanced clinical, teaching and research excellence in joint reconstruction and replacement. Finally, a warm welcome to Dr. Anna Greenwood MD, a prior resident at VCU Health, who returns from a Tumor fellowship at Emory University in Atlanta, GA, as an attending in Orthopaedic Oncology and Infection.

Patient Optimization and Enhanced Recovery after Surgery
I wanted to conclude by highlighting the importance of patient optimization prior to surgery and ERAS. These principles have gained immense attention and an increasing number of studies are being published reflecting implementation nationwide, including here at VCU Health. With joint replacement surgery, patients are being optimized according to stringent criteria for body mass index, hemoglobin levels, smoking status, illicit drug use, albumin levels and diabetes control. The aim is to reduce complications and improve patient outcomes, which has been demonstrated in our ongoing studies soon to be presented nationally. These measures are having a significant positive impact for patients, hospitals and society as a whole, when avoiding the morbidity, mortality and cost associated with complications such as prosthetic joint infection.

As part of this, we are standardizing and streamlining care to facilitate ERAS in all surgical specialties to improve outcomes, and reduce complications and length of stay. I am proud to represent my orthopedic partners at the ERAS committee for VCU Health, where it has been made a top priority for all patients undergoing surgery.