Callaghan focuses on need for national joint registry

By: Jennie McKee

By Jennie McKee

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Incoming first vice president will also make enhancing patient care, increasing orthopaedic unity top priorities

John J. Callaghan, MD, acknowledges that building a national joint registry in the United States will be a complex task—he’s also optimistic that it can be accomplished.

When he assumes the presidency of the AAOS in 2010, Dr. Callaghan will put a special emphasis on continuing the development of a national joint registry, and will also help focus the Academy’s efforts to enhance patient care and increase orthopaedic unity.

John J. Callaghan, MD

Accomplishing a “massive undertaking”

According to Dr. Callaghan, who specializes in adult reconstruction—specifically, hip and knee joint replacement—a U.S. joint registry would provide invaluable insight into the epidemiology of total joint arthroplasty that could help achieve better patient outcomes. A number of issues, however, have made creation of a national joint registry difficult—most notably, the amount of data that would need to captured.

“Approximately 15 countries around the world have joint registries,” he says. “All of them combined are only tracking 150,000 to 200,000 joint replacements each year. In the United States, however, we’re performing about 750,000 joint replacements every year, which means that our registry would need to be three to four times the size of all the other joint registries combined. Tracking that many joint replacements will be a massive undertaking.”

Several factors, however, may soon make it easier to create a national joint replacement registry.

“The emphasis that the public and the government are placing on qual­ity of joint replacements right now increases the potential for the creation of a joint registry,” says Dr. Callaghan. This attention has translated into action at the federal level, including the U.S. Food and Drug Admini­stration’s efforts regarding unique identification for medical devices.

In response to the December 2008 AAOS Board of Directors action that a basic registry be implemented within approximately 12 months, the American Joint Replacement Registry Oversight Board sought proposals from organizations qualified to provide comprehensive project management assistance. On Monday, the Board granted approval for a $300,000, 12-month budget for project management assistance.

Other goals for the AAOS

According to Dr. Callaghan, improving patient care will be another priority for the Academy.

“We not only need to provide great care, but we also need to provide that care in an efficient, cost-effective manner,” he says. “That’s a huge challenge because the number of regulatory issues and requirements placed on physicians require them to spend more time and use more resources to accomplish their jobs.”

Dr. Callaghan says that the unity effort is also high on his agenda.

“I consider myself an orthopaedic surgeon first, and a joint replacement specialist second,” he says. “It’s important for the Academy to have good relationships with the organizations that make up the Board of Specialty Societies because a significant percentage of AAOS members have specialty interests. In addition, AAOS members with a specialty focus are the heart and soul of our educational programs.”

Navigating current challenges

Defining “quality” as it relates to health care will be a significant issue for the AAOS now and in the future, according to Dr. Callaghan.

“The AAOS has worked very diligently to provide world-class continuing medical education offerings, and has created effective initiatives related to research and advocacy. We don’t know, however, exactly what the public, government, and insurance companies perceive as ‘quality health care.’ We want to make sure that we’re at the table during those discussions so that we help formulate appropriate measures of quality.”

The AAOS will also continue to analyze its educational programs and ensure that they fit the requirements of organizations such as the Accreditation Council for Continuing Medical Education.

In addition, the ongoing investigation of the U.S. Department of Justice (DOJ) into orthopaedic surgeons’ relationships with industry continues to have an impact.

“There’s no question that the DOJ investigation has given orthopaedic surgery a bit of a black eye,” he states. “Fortunately, the AAOS had been proactive, with the adoption of the Standards of Professionalism (SOPs) on Orthopaedist-Industry Conflicts of Interest. The SOPs clearly state that illegal and unethical behavior among orthopaedic surgeons will not be tolerated by the AAOS and members who have violated the SOPs may be sanctioned.”

Finally, says Dr. Callaghan, it’s crucial for the AAOS to work with the American Board of Orthopaedic Surgery (ABOS), particularly regarding its Maintenance of Certification™ (MOC) process.

“The Academy is positioned to help our members manage MOC as efficiently as possible and to help communicate how it will help them provide better care to their patients,” he said.

Educational background and mentors

Dr. Callaghan’s introduction to orthopaedics was the result of a “lucky break,” of sorts.

“When I was 10 years old, I broke my arm,” he says. “My interest in orthopaedics began with that injury. When they put that cast on, I thought to myself that I wouldn’t mind doing that when I grew up.”

A graduate of Notre Dame University in South Bend, Ind., and Loyola Medical School in Chicago, Dr. Callaghan met several role models and mentors who shaped his career during his orthopaedic residency.

“I was very fortunate to be accepted at the University of Iowa for my residency,” says Dr. Callaghan. “Some of the senior faculty who served as important mentors include two past presidents of the AAOS: Reginald R. Cooper, MD, who was the chair of the department of orthopaedics and rehabilitation; and Stuart Weinstein, MD. Ignacio Ponseti, MD, and Richard C. Johnston, MD, also influenced me greatly.

Dr. Callaghan says that Dr. Cooper instilled in him the need for discipline and efficiency, while Drs. Weinstein and Ponseti taught him how to deliver exemplary patient care.

“Dr. Johnston, whom I consider to be my ‘father in hip surgery,’ taught me the importance of applying the basic sciences to clinical practice,” he says.

Dr. Callaghan met several other mentors during his fellowship at the Hospital for Special Surgery in New York.

“There’s no question that fellowship directors are hugely important to any physician who wants to focus on a specialty,” says Dr. Callaghan. “Those who made the most important impressions on me at the Hospital for Special Surgery included Eduardo A. Salvati, MD; Philip D. Wilson Jr., MD, a past president of the AAOS; John Insall, MD; and Chitranjan S. Ranawat, MD.

“There’s not a day that goes by in my clinical practice, either in the operating room or outpatient clinic, that I don’t apply the things that they taught me more than 25 years ago,” says Dr. Callaghan.

Professional accomplishments

Dr. Callaghan continues to benefit from the relationships he forged during his residency at the University of Iowa. He is currently a professor in both the department of orthopaedics and the department of bioengineering at the school’s college of medicine.

“I call my office the ‘corner pocket’—Dr. Weinstein’s office is on one side, and Dr. Ponseti’s office is on the other side,” he says. “Working with them is very inspiring. At the age of 91, Dr. Ponseti continues to mentor me.”

Dr. Callaghan also devotes much of his time to orthopaedic research. The author or co-author of more than 230 peer-reviewed publications, he has received many honors and accolades, including the John Charnley Hip Society Award from the Hip Society as well as the Knee Society’s Insall Award.

“I feel blessed to see the way we’ve progressed in hip replacement, not only in the designs of the prostheses, but in the management of the patients afterwards, including pain management and rehabilitation.

“We’ve tried to make the hip replacement procedure as efficient as possible and to decrease the cost,” he adds. “Hip replacement is now recognized as one of the best values in medicine.”

Dr. Callaghan has also served as a leader of many orthopaedic organizations. He is the former vice president of the ABOS as well as a past president of the American Association of Hip and Knee Surgeons, the Iowa Orthopaedic Society, the Hip Society, and the Mid-America Orthopaedic Association. He has also served as the chair of the Orthopaedic Research and Education Foundation.

He notes that these leadership positions have helped prepare him to serve as a leader of the AAOS.

“Of all the issues facing orthopaedic societies, I think those that we face at the Academy are some of the most challenging,” he says. “It’s a great honor to be elected to such as position.”