Q&A With Dr. Alejandro Gonzalez Della Valle, Orthopedic Surgeon at the Hospital for Special Surgery

Written by Rob Kurtz | April 26, 2010 | Print  |
Alejandro Gonzalez Della Valle, MD, is an orthopedic surgeon specializing in hip and knee surgery at the Hospital for Special Surgery in New York.

Q: Is there a specific new surgical technique or technology that is most exciting to you and why?

AGDV: In the span of a decade, hip and knee surgeons have witnessed the development and introduction of new techniques, technology like minimally invasive surgery, materials that allow enhanced uncemented fixation of implants, modern metal-on-metal and ceramic-on-ceramic bearings and so called "computer-assisted surgery" or "computer navigation".

In my opinion, computer navigation is revolutionizing the way we think and approach joint replacement surgery. Adequate positioning of prosthetic components is essential for the joint replacement to function as similarly as possible to the natural joint and to diminish the natural wear and tear of the mechanical parts. The ability to properly position the different prosthetic components during total joint replacement increases with a surgeon's experience; however, even in the most experienced hands, there will be a proportion of patients with malpositioned components. This may result in early prosthetic failure and complications. With the proper use of computer navigation, the number of "outliers" has diminished, resulting in a more consistent positioning of the replacement parts. This technology is evolving at a fast pace and will eventually be easier to use and available to the high and low volume surgeon. Its systematic use will likely result in more consistent total joint replacement outcomes.

Q: Is there an initiative undertaken at Hospital for Special Surgery in the past year that has proven to be beneficial and that you are particularly proud of?

AGDV: Hospital for Special Surgery has been a pioneer in perfecting and streamlining the execution of total hip and knee replacement. The advances in anesthesia, surgical technique and perioperative care are based on extensive basic, applied and clinical research that has been performed in HSS over that last four decades. HSS physicians, researchers and allied healthcare professionals are committed to continue building upon the previously mentioned body of research to make hip and knee replacement even safer and more cost effective.

Q: What do you see as the biggest opportunities for orthopedics in the next few years?

AGDV: The number of hip and knee replacements performed yearly in the US has increased exponentially in the last decade due to the baby-boomer effect, as well as the expansion of indications for surgery to the younger and to the sicker patients [1,2, 3]. However, the number of orthopedic surgeons specializing in joint replacement surgery has been declining [2]. By 2016, the United States is likely to experience a significant shortage of orthopedic surgeons willing to do total joint replacements. If these predictions are accurate, 72 percent of those who need total knee replacements and 50 percent of those who need total hip replacements will not be able to obtain them [2]. Consequently, the arthroplasty workforce will be unable to meet the needs of a growing arthritic population. Joint replacement surgeons and hospitals will face the challenge of efficiently coping with the increase in volume while maintaining safety standards. Surgeons and hospitals will need to work together to increase efficiency.

Q: What factors have been critical to your professional success and popularity with patients, as indicated by your receiving the 2008 Patients' Choice Award from Vitals.com for being one of New York's favorite physicians?

AGDV: Hip and knee replacement surgeons treat patients who usually require "elective" surgery. This means that the patient is the one who ultimately makes the decision to have his or her hip or knee replaced. I make it a priority in my practice to convey a balanced view of benefits and drawbacks of the surgical procedure recommended for each patient, and in addition, I try to set realistic expectations for recovery. I respect my patients' free will and trust their ability to make an educated decision for their own medical care. Allowing patients to speak and listening to their complaints and concerns have proven valuable in gaining my patients' trust.

Q: What are your professional goals this year and for the next few years?

AGDV: Based on the previously mentioned challenges and the changes seen in the last decade, my goal for the following years is to continue striving for an orthopedic practice that balances patient care, education and research, which, to me, are the three indispensable pillars for the growth of orthopedic knowledge.

Learn more about Dr. Alejandro Gonzalez Della Valle.

References:
1. Memtsoudis S, Gonzalez Della Valle A, Besculides S, Garber L, Laskin R. Trends in demographics, comorbidity profiles, in-hospital complications and mortality associated with primary knee arthroplasty. J of Arthroplasty 2009;24(4):518-527.

2. Kurtz S, Lau E, Ong K, Zhao K, Kelly MP, Bozic KJ. National projections of younger patient demand for primary and revision joint replacement. 2009 AAOS Annual Meeting Podium Presentations #183.

3. Odum SM, Iorio R, Fehring TK. Joint replacement access in 2016: A supply side crisis. 2009 AAOS Annual Meeting Poster Presentations #P043.

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