The Engineering of Better Joint Replacement Outcomes: Q&A With Dr. Geoffrey Westrich of Hospital for Special Surgery

Orthopedic Sports Medicine

Dr. WestrichGeoffrey Westrich, MD, is research director of Adult Reconstruction and Joint Replacement Service at Hospital for Special Surgery in New York City. He is also co-chair of the hospital's Infection Control Committee, co-chair of the Thromboembolic Disease Review Committee and co-chair of the Complex Case Pre-Operative Review Panel. He also serves as an associate professor of orthopedic surgery at Weill Cornell Medical College.
Dr. Westrich discusses how engineering steered him towards orthopedics, the changes he has seen in joint replacement and how joint replacement will continue to evolve.

Q:  What attracted you to the field of orthopedics?

Dr. Geoffrey Westrich: I studied engineering as an undergraduate at Tufts University and was especially interested in biomedical engineering. It was fascinating to use engineering principles to solve complex medical problems. I was later attracted to orthopedics because it's the one specialty that incorporates engineering and medicine to devise solutions to improve mobility, reduce pain and to give patients a better quality of life.

Q: What are the most significant changes you have seen in the field of orthopedics since you began practicing?

GW: The main improvements have been in joint replacement design and in the instrumentation we use, and in our ability to improve patient outcomes while also minimizing risk to the patient. The improvements allow us to be more accurate with smaller incisions and less trauma to the body, with better results.

Q: Are there any research developments in orthopedics that you are currently excited about?

GW: There are newer kinds of joint replacements that are allowing better range of motion with less pain. The surgery can be done more expeditiously with fewer complications, such as dislocation.

Another exciting area of research concerns the use of regional anesthesia (neuraxial anesthesia) with deep sedation in total joint replacement and other orthopedic procedures. Recent studies show very favorable outcomes.

I believe the use of regional anesthesia has revolutionized anesthetic techniques for orthopedic cases. Not only are patients much more comfortable; they don't have the risks and side effects of general anesthesia. Regional anesthesia is safer and better tolerated, and it lowers the risk of bleeding and blood clots.

Another significant development concerns operating rooms designed with laminar air flow. Hospital for Special Surgery has a very low infection rate, and the operating room design is one of the factors.

Q: How much do you think reconstructive and joint replacement surgery will change over the next five years?

GW: It is predicted that the number of joint replacements will increase dramatically over the next five years, and in general, patients are becoming more educated and aware. Studies are showing that if people want the best result possible, they are better off going to a hospital and surgeon that do a high number of joint replacements. As people become more educated patients, they will likely be willing to travel to a high-volume joint replacement center outside of their neighborhood if it means improving the chances for a good outcome with less risk of a complication.

I believe joint replacement surgery will continue to become safer over the next five years. We are able to identify patients at risk for certain problems by screening them beforehand.  

Over the next five years, prostheses will continue to improve and the instrumentation that we use to put in the prosthesis will continue to evolve. I believe surgical techniques, infection control and blood clot prevention will also continue to improve.

Q: What do you hope to accomplish in the future as an orthopedic surgeon?

GW: I hope to continue to provide excellent, high-level care to my patients and allow them to have an excellent outcome in their hip and knee surgery. I would like to continue to share our vast experience in orthopedics at HSS with other health professionals who are interested, so they can take advantage of HSS's expertise and findings concerning best practices.

Regarding the hospital's joint replacement registry, we will continue to collect data on outcomes and best practices by entering patients into the registry. It gives us the unique ability to follow patients over time by contacting them, making sure they come in for follow-up appointments and tracking their prosthesis and their progress.

A series of articles featuring orthopedic surgeons on issues ranging from personal background to current research developments is published weekly. We invite all orthopedic surgeons and sports medicine specialists to participate.

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More Articles on Sports Medicine:
Dedication in Orthopedics & Challenges Ahead: Q&A With Dr. Jonathan Fox of Arizona Orthopaedic Associates
Technology in the World of Orthopedics: Q&A With Dr. Paul Papierski of MidAmerica Orthopedics
The Art of Orthopedics & What Lies Ahead: Q&A With Dr. Barbara Bergin of Texas Orthopedics, Sports and Rehabilitation Associates

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