Week 4

This past week I was fully immersed into clinical side of osteoarthritis treatment.  After several weeks which were more focussed being immersed in the research at HSS, I spent this entire week shadowing my clinician advisor, Dr. Bostrom, to all of his clinic appointments and surgeries.  On Monday and Thursday I was in the OR observing a variety of surgeries, on Wednesday and Friday I was observing appointments in the HSS clinic, and on Tuesday I went to the Helen Hayes Hospital to observe the clinic there.  All of this was very interesting and I really was able to see the entire process of joint replacement from a clinical prospective going from the diagnosis and recommendation of surgery, the surgeries themselves, the recovery process up to years after surgery, and even a re-implantation of an old failed implant.

I saw a range of surgeries this week which were very interesting.  On Monday I was able to see several more hip and knee replacements which remains very fascinating to observe.  On Thursday there were some different and more complex surgeries including an arthroscopic knee surgery on a patient with a total knee replacement, a re-implantation surgery in which a failed total hip replacement was removed and replaced with a new one, and a total knee replacement surgery that required specifically made tibial and femoral components due to the patients unique anatomy and that were custom designed by the biomechanics team here at HSS.

In both clinics I was able to observe a variety of appoints with Dr. Bostrom.  The majority of these appointments were related to a total joint replacement, either prior or post surgery.  In some appointments the patients, who had severe joint pain, radiographic evidence of OA, and had exhausted conservative treatment measures, were told that they would require a total joint replacement.  These were interesting to observe because of the variety of reactions patients had to this news; some were understandably concerned about the major operation while others seemed relieved to finally have an option to get rid of their pain and lack of mobility.  There were also follow-up appointments with patients who already had their surgeries as little as 6 weeks prior up to about 20 years prior.  It was amazing to see how fast people recover from this major surgery - most were doing quite well 3 months out.  It was also interesting to see a variety of cases were surgery was very successful (most patients) but also some cases where there were some continued surgical complications long after the operation.

Overall, this week contained an overwhelming amount of information and clinical observation.  I learned a ton about the entire process of joint replacement and remain amazed by the operation and its recovery.  I am also amazed by all the hard work put in by Dr. Bostrom and his team.  Its amazing to think that they see this many patients every week and are able to deliver great quality care to all of them.  It also really put into perspective the clinical need for alternate OA treatments other than TJR which really provides motivation for my research moving forward.  These surgeries are challenging and painful but are ultimately the only current method to successfully fix a joint with severely degenerated cartilage.