Orthopaedic News THE LATEST NEWS FROM THE DEPARTMENT OF ORTHOPAEDICS & SPORTS MEDICINE. Chairman s Message pg 1

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1 Orthopaedic News SPRING 2012 THE LATEST NEWS FROM THE DEPARTMENT OF ORTHOPAEDICS & SPORTS MEDICINE Inside Chairman s Message pg 1 Case Study: Mastering a Promising Approach pg 2 Physician Spotlight: Practicing What He Preaches pg 3 Services for Physicians pg 4

2 Chairman s Message Dear Colleague, We are pleased to share with you the Spring 2012 edition of Orthopaedic News. This issue highlights many of our integrated and evolving approaches to clinical care, research and academics here in Cleveland Clinic Florida s Department of Orthopaedic Surgery. In 2011, for the second year in a row, U.S. News & World Report ranked our hospital as number two of 18 hospitals in the Miami-Fort Lauderdale metropolitan area. The report also recognized our orthopaedics department with a high performing designation in its regional rankings. These rankings are reflective of our individual subspecialist s strengths and the synergy between all members of our department which enhances our commitment to patient care. As healthcare reform moves toward an environment that emphasizes quality of care and patient satisfaction, our experienced staff is strengthened by an established presence in the community and through communication with our patients and colleagues throughout the region. Patients seen in our department benefit from a multidisciplinary approach that is emphasized by working closely with our Spine Care Center, Physical Rehabilitation, Radiology and Sports Health departments. We recently expanded our ancillary services by adding a nurse practitioner who is well versed in assisting patients throughout their hospital stay following joint replacement surgery. Physician assistants on staff compliment treatment by offering support to our surgeons and the patients they treat. The efforts of each team member is further enhanced by a fully integrated electronic medical record system that allows for consistent communication between all of our service providers. Our overall approach to care is reflected in this issue of Orthopaedic News. The adoption of the anterior approach for hip arthroplasty is gaining preference by today s patients and Cleveland Clinic Florida is one of few hospitals in the region to offer this minimally invasive approach. On page 2, Drs. Preetesh Patel and Juan Suarez highlight our expanding abilities and successful outcomes of this technique. We also highlight the inspiring career of Dr. David Westerdahl, whose early life experiences have shaped his work in primary care and sports medicine. In addition to treating a wide range of non-operative orthopaedic and sports medicine injuries, Dr. Westerdahl holds several positions within the community including team physician for the Florida Panthers hockey team. Gregory Gilot, MD Chairman, Department of Orthopaedic Surgery Specialties include: Arthroscopic surgery of the shoulder, hip and knee; shoulder and ACL reconstruction; disorders of the rotator cuff; degenerative and inflammatory arthritis of the shoulder; fractures about the shoulder girdle A primary component that melds the talents of our staff is our continued pursuit of academic excellence. As a leader in innovation, our dedication to continued education is seen in numerous studies our group publishes each year. Among these is the study Surgical Outcome Following Arthroscopic Fixation of Acromioclavicular Joint Disruption with the TightRope Device (Orthopedics Jul; 34(7):e267-74) and an active prospective, randomized trial comparing wound healing and appearance with the use of a wound protective device during direct anterior hip arthroplasty - both of which are hopeful contributions to the orthopaedic literature). We hope you will enjoy learning about our efforts. Gregory Gilot, MD Rated High Performing in 10 Specialties Cancer Diabetes & Endocrinology Gastroenterology Geriatrics Gynecology Nephrology Neurology & Neurosurgery Orthopaedics Pulmonology Urology

3 Case Study: Mastering a Promising Approach Anterior Approach for Hip Arthroplasty By Preetesh D. Patel, MD and Juan C. Suarez, MD As one of the most successful techniques in modern surgery, the total hip replacement is renowned for restoring function and reversing incapacitating hip pain. Yet, it is the adoption of the anterior approach for hip arthroplasty that is changing today s method due to its emerging frequency and most notably, patient demand for the promise of a minimally invasive surgery that provides numerous benefits. While the anterior approach for hip arthroplasty has gained popularity in the United States throughout the last two decades, the reality is that currently only a small percentage of hip surgeons offer the technically demanding procedure. As the approach has been improved through the use of specialized operating tables and modified instruments allowing for a more precise and safe operation, ongoing education and clinical experience are required for the technique s success. Cleveland Clinic Florida is one of few hospitals in the region to offer minimally invasive direct anterior hip replacement surgery, with up to 40 of the procedures completed monthly. The anterior approach uses a true internervous plane with less soft tissue trauma making the recovery faster and less painful for patients. Typically, patients are discharged in one to two days and the need for walking assistive devices is eliminated in less than two weeks, and often within a few days. Increasing successful outcomes and patient satisfaction from use of the anterior approach at Cleveland Clinic Florida is a result of a commitment to direct surgeon education and a team approach and collaboration with others who are employing the technique. Utilizing a cadaver training lab, attending national meetings and accessing web-site training allows for the team of orthopaedic surgeons to communicate results as well as their challenges. A demanding technique, the anterior approach is infamous for its steep learning curve. Performing the operation without a specialized table requires more assistance, particularly during femoral exposure. Additionally, implant impaction with the patient in the supine position increases difficulty due to different tactile feedback it provides the surgeon. The technique has also shown to result in increased blood loss over traditional approaches. Attention to the use of bipolar cautery, drains and cell savers are essential details that when added help ensure successful results. With increased clinical experience, the anterior approach for hip arthroplasty is a precise surgical technique that with component positioning can decrease early complications, such as instability and leg length discrepancy, while also minimizing the risk of revisions. As patients increase their demand for a surgical technique that offers faster recovery and a quicker return to a productive lifestyle, the emphasis on a total team commitment is central to the anterior approach. Preoperative and postoperative education regarding the anterior approach is delivered by the department s ancillary providers in addition to timely coordination of physical therapy aid, which in the success of a procedure that is still being perfected by surgeons nationwide. Through continued communication among all members of the care provider team, transition from surgery to recovery is eased for the patient and their ongoing needs. Contact Our Experts Drs. Patel and Suarez at or patelp4@ccf.org and suarezj@ccf.org Preetesh Patel, MD Orthopaedic Surgeon Dr. Patel s specialties include: Degenerative and inflammatory arthritis of the hip and knee; complex primary and revision hip and knee replacements; minimally-invasive primary hip and knee replacements; minimally invasive direct anterior hip replacements unicompartmental knee replacements; computer-assisted (navigation) hip and knee replacements; traumatic fractures lower extremity Juan Suarez, MD Orthopaedic Surgeon Dr. Suarez s specialties include: Primary hip and knee arthroplasty; revision hip and knee arthoplasty; direct anterior hip arthoplasty; fracture treatment

4 Physician Spotlight: Practicing What He Preaches David Westerdahl, MD, Uses Life s Lessons & Lifestyle to Deliver Tailored In-Office Orthopaedic Care As a child, David N. Westerdahl, MD, experienced first hand the impact orthopaedic care can have on those who need it the most. With a father who suffered from polio, Dr. Westerdahl was shown how ongoing interaction with orthopaedists and musculoskeletal specialists was an integral part of his father s recovery and the ability to regain his quality of life. It was my father s experience and my close relationships with a family member who was an orthopaedic surgeon and a family medicine physician that inspired me to take the same path in my career, says Dr. Westerdahl. My daily goal is to help patients optimize their quality of life and get back to the activities they enjoy. With a background in primary care and sports medicine, Dr. Westerdahl manages a wide range of non-operative orthopaedic and sports medicine injuries through an in-office setting at Cleveland Clinic s Weston campus. Based on training that includes a fellowship in the Department of Orthopaedic Surgery at Cleveland Clinic s main campus in Cleveland, Dr. Westerdahl has spent the last eight years managing a consistently busy practice seeing a wide variety of sports injuries and other orthopaedic conditions. Taking on the primary role as gatekeeper by completing thorough histories and physical exams for each patient, he provides non-operative care for problems ranging from a rotator cuff tear and hip arthritis, to tennis elbow and shoulder fractures. the pre-op, intra-op and post-op, they rely on me to manage acute injuries or those that are a result of accumulative wear and tear over time. For those patients not requiring surgery, I help them navigate treatment options like physical therapy, bracing, medication, injections and newer treatments such as ultrasound-guided platelet rich plasma injections. As a compliment to his sports medicine specialty Dr. Westerdahl has an active lifestyle which includes running marathons and triathlons, a continuation of his days participating in high school sports. He admits that suffering concussions and elbow and knee injuries during his early years as an athlete has made him empathetic to the wide variety of patient needs from a teenage football player to a 70-year-old woman who is yearning to rejoin her tennis league. Dr. Westerdahl s enthusiasm for sports medicine is further illuminated by serving as a team physician for the Florida Panthers hockey team, a consulting physician for the United States Tennis Association (USTA) Development Center in Boca Raton, and as team physician for The Sagemont School in Weston. Dr. Westerdahl is one of the key components of our overall approach to care, says Gregory Gilot, MD, Chairman, Department of Orthopaedic Surgery. He offers answers to many patients who think surgery is their only option. As the region s needs for in-office orthopaedic care grows, both patients and the department s surgeons utilize Dr. Westerdahl s approach. Through appropriate triaging, he offers non-operative options for the majority of patients who can be treated effectively without surgery. Two additional staff members team up with Dr. Westerdahl to manage patients in Weston, and a third sees patients in the West Palm facility. The surgeons look to me to manage cases through in-office services that help decompress their schedules, Dr. Westerdahl explains. While they have a lot of experience managing patients through Contact Our Expert Dr. Westerdahl at or westerd@ccf.org David Westerdahl, MD Head, Section of Medical Sports Medicine, Medical Director, Physical Therapy & Rehabilitation Services Dr. Westerdahl s specialties are: Non-surgical sports medicine and sports-related injuries, non-surgical orthopaedics; exercise-related medical disorders; arthritis; musculoskeletal ultrasound and platelet-rich plasma (PRP) therapy; fractures; concussion

5 Services for Physicians Track Your Patient s Care OnlinE Our practice-tested DrConnect service elevates the team approach to a new level by giving you and your staff an instantaneous, comprehensive and secure online view of your patients treatment progress while at Cleveland Clinic. With DrConnect, our specialty care becomes a seamless part of your practice, providing you added confidence when making decisions regarding the next step in your patients care. To get more information or to sign-up online, please visit clevelandclinic.org/drconnect or call our DrConnect help desk at Request for Medical Records , ext Remote Consults Online medical second opinions from Cleveland Clinic s MyConsult are particularly valuable for patients who wish to avoid the time and expense of travel. Visit clevelandclinic.org/myconsult, eclevelandclinic@ccf.org or call , ext Outcomes Data View the department s latest clinical outlook book by visiting my.clevelandclinic.org/florida/departments/orthopaedic_surgery/default.aspx Department Triage Hotline hillc7@ccf.org Services for Patients APPOINTMENT CENTER Coming Event UPDATE IN JOINT RECONSTRUCTION SURGERY Oct , 2012 Westin Beach Hotel and Conference Center Fort Lauderdale, Florida Register at ClevelandClinicFloridaCME.org

6 Cleveland Clinic Florida Department of Orthopaedic Surgery 2950 Cleveland Clinic Blvd. I Weston, FL ORTHOPAEDIC NEWS SPRING 2012 THE LATEST NEWS FROM THE DEPARTMENT OF ORTHOPAEDICS & SPORTS MEDICINE Cleveland Clinic Florida, located in Weston and West Palm Beach, is a not-for-profit, multi-specialty, academic medical center that integrates clinical and hospital care with research and education. Cleveland Clinic Florida has more than 215 physicians with expertise in 35 specialties. The medical campus is fully integrated and includes diagnostic centers, outpatient surgery and a 24-hour emergency department located in the state-ofthe-art hospital. Cleveland Clinic Florida ranked second among the 18 best hospitals in the Miami-Fort Lauderdale metro area in US News & World Report s first-ever ranking of Best Hospitals metro area rankings. Cleveland Clinic Florida is an integral part of Cleveland Clinic Ohio, where providing outstanding patient care is based upon the principles of cooperation, compassion and innovation. Physicians at Cleveland Clinic are experts in the treatment of complex conditions that are difficult to diagnose. For more information about Cleveland Clinic Florida, visit