Orthopedic surgery often celebrates the operation. Gabriella Ode, MD, believes the operation is rarely what determines whether a patient’s overall care ultimately succeeds.
As an orthopedic sports medicine and shoulder surgeon at New York City-based Hospital for Special Surgery and director of the HSS Orthopaedic Sports Medicine Fellowship, Dr. Ode reconstructs shoulders for everyone, from recreational athletes to professionals. She serves as head team orthopedic surgeon for the WNBA’s New York Liberty and assistant team orthopedic surgeon for the NBA’s Brooklyn Nets.
Her philosophy, however, begins well before the operating room.
When patients arrive in her clinic, she is often less interested in what an MRI shows than in what the patients hope to get back to doing. By the time an injury brings someone into her office, she said, it is often affecting far more than physical function. It is changing their daily routine, their well-being and, in many cases, their sense of identity.
A technically successful procedure means little, she argues, if it does not fit the realities of a patient’s life or if the recovery required to achieve a good outcome is never completed.
That is why she sometimes recommends against an operation a patient is medically eligible to receive.
“Avoiding paternalistic behavior is something that’s important with surgeons, which is to not tell somebody, ‘Hey, you have to do this.’ It’s to explain to somebody, ‘Here’s what recovery for this means, and how this will fit in your life,’ and then allow them to be able to make an educated, informed decision,” Dr. Ode told Becker’s.
The surgery is only part of the recovery
For Dr. Ode, surgery is only one phase of treatment. Recovery often determines the final outcome. She pointed to rotator cuff repair as one example. Patients frequently focus on the operation itself, but the months that follow often matter even more.
“A patient may really want to have their rotator cuff repaired, but if they don’t want to do the physical therapy afterwards, they are setting themselves up for an insufficient recovery by not doing the other 70% of what is needed” she said. For Dr. Ode, the operation begins the recovery. It does not complete it.
Sometimes the obstacle is not motivation. It is access.
Patients may struggle to find transportation, afford therapy or schedule appointments around work and family obligations. In those situations, Dr. Ode said, her responsibility extends beyond performing surgery. It includes helping patients overcome the barriers that determine whether the operation ultimately succeeds.
When research asks the wrong question
Dr. Ode believes orthopedic research has undergone a similar evolution. For years, much of the evidence guiding sports medicine was generated primarily from studies involving male patients. Only recently has the field begun examining how that imbalance may have influenced what physicians believed they knew.
“It lacks recognition of how sex characteristics can potentially affect healing and recovery, and sometimes I think that creates unnecessary statistical bias,” she said.
Again, she pointed to rotator cuff repair as an example.
“For a while there were a litany of studies that said that women have worse outcomes or higher complication rates after rotator cuff repair, compared to men,” she said.
Those conclusions, she argues, often failed to account for important variables that influence outcomes regardless of sex, including delayed diagnosis, inflammatory arthritis and osteoporosis. Rather than concluding that women simply experience worse outcomes, Dr. Ode believes researchers should identify which factors can actually be modified.
“Understanding that there may be certain processes we see in certain sexes that we can optimize is a better way to improve care for both men and women,” she said.
Treating professional athletes differently — and the same
Professional athletes often face enormous external pressure to return to competition. Dr. Ode said that pressure never changes who her patient is. “The relationship, first and foremost, is with us and the patient,” she said. “That’s beyond any kind of external pressure.”
Whether she is caring for a professional basketball player or someone hoping to return to gardening or pickleball, the process begins with the same questions. What does the patient understand about the injury? What do they want their recovery to look like? The treatment plan is then built around those answers.
She also believes communication becomes increasingly important as more people become involved in an athlete’s care: strength coaches, athletic trainers, physical therapists, nutritionists, agents and coaches.
Rather than allowing those conversations to occur separately, she prefers bringing everyone together. “We’re all on the same conference call, we’re all in the same room, we’re discussing all aspects of this care,” she said. For all the visibility surrounding elite sports, Dr. Ode sees remarkably little difference between those patients and everyone else.
“It’s basically just a more heightened version of the experience that non-athletic patients have,” she said.
Why technology matters most at the margins
Dr. Ode was an early adopter of computer-navigated shoulder replacement. She also speaks candidly about its limitations.
She disclosed that she works as a consultant and serves on the navigation design team for one of the companies. Her support for the technology is not rooted in the belief that surgeons should rely on computers. It is rooted in the belief that even experienced surgeons benefit from better information.
“I have enough humility to know that we’re humans, and if we can use additional information about anatomy and geometry and orientation to help our eyes and our hands, we should use it,” she said.
Shoulder replacement already produces excellent outcomes for most patients. The goal of navigation, Dr. Ode said, is not to reinvent a successful operation. It is to make good surgery more consistently good by reducing the small technical variations that can influence long-term outcomes. “It helps to calm down the outliers,” she said. That consistency becomes especially valuable for patients with smaller anatomy.
“We’re talking about a room for error that’s millimeters,” Dr. Ode said, describing many of the elderly women she treats. Even subtle differences in implant positioning can influence soft-tissue tension, implant fit and the long-term durability of a reconstruction.
The surgery that sometimes has to wait
One question has become routine before many of Dr. Ode’s shoulder replacements.
“One of the first questions I ask them now is, ‘Have you had a [dual-energy X-ray absorptiometry] scan?'” she said. “I am surprised as to how many women say no.”
If a patient has untreated osteoporosis or has never undergone bone-density evaluation, she often pauses surgical planning altogether.
“I will pause their scheduling of a shoulder replacement until I have made sure that they’ve seen the appropriate consultants to have a discussion with them about optimizing bone health,” she said.
For Dr. Ode, bone quality is no longer a separate issue managed after surgery. It is part of surgical planning itself. That reflects what she sees as a broader shift across orthopedics. “We, as orthopedic surgeons, understand that bone health is a critical part of how we manage these patients,” she said. “We’re doing a better, not a great job, but a better job of making sure that patients are considering their bone health when we’re talking about orthopedic injuries.”
For decades, orthopedic innovation has largely focused on improving the operation. Dr. Ode believes the next advances may come from improving everything that surrounds it. The conversations before surgery. The rehabilitation afterward. The evidence that guides treatment. The bone health beneath the implant.
Because in her view, patients rarely remember an operation simply because it was technically perfect. They remember whether it gave them their lives back.
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