Orthopaedic Practice and Research Are Team Efforts

Editor’s note: This interview is a companion piece to the article “Collaboration between Specialty Societies and AAOS Is the Key to Advancing Orthopaedics.”

Richard F. Kyle, MD, FAAOS, is a past president of AAOS and past president of the Orthopaedic Research and Education Foundation (OREF). He spoke with Robert M. Orfaly, MD, MBA, FAAOS, editor-in-chief of AAOS Now, to share his perspectives on how the orthopaedic community has worked together to advance knowledge and apply the best treatment for every patient.

Dr. Orfaly: Let’s get the conversation started with your thoughts about orthopaedic unity, especially when it comes to the care of the patient with musculoskeletal conditions.

Dr. Kyle: We as orthopaedic surgeons have one goal: to get our patients back to activities, both work and recreation. That’s done through care of the musculoskeletal system, whether it’s a fractured bone, a torn tendon, some other type of musculoskeletal injury or other disease. As orthopaedic surgeons, our goal is to relieve pain, increase mobility, and get the patient back to a normalized lifestyle.

Whether we are sports surgeons, hip surgeons, foot and ankle surgeons, trauma surgeons, we’re one group of physicians, and the key word is physicians. We are doctors first, and we take care of patients of all ages from the time they are a baby with club feet or congenital hip dislocation through their golden years when they suffer from a fractured hip.

We also take care of multiple comorbidities that affect the musculoskeletal system. All injuries or diseases are taken care of, sometimes differently depending on the age, both physiologic and chronologic, and activity level of the patient. All those elements go into care, but the bottom line is we are all orthopaedic surgeons who work together to mobilize people to return to work and recreation.

Dr. Orfaly: The team concept is certainly something that we hear a lot about today. I think that how you view things is that we are part of the bigger team to take care of musculoskeletal problems.

Dr. Kyle: Absolutely, and that’s a great term, Dr. Orfaly, because we are a team, and it takes effort as a team to care for our patients. When we walk into the OR to do surgery, we need a team to help us. At one point in time, there were mostly general orthopaedists. Now with the increased knowledge we have about specific areas of the body, we see specialized care of each area of the musculoskeletal system. We are all part of a team that has one goal: to relieve pain and mobilize the patient.

We don’t operate as an individual on all musculoskeletal conditions anymore. We need to refer to other specialists, and they’ll refer back to us. For me, as a hip, knee, and trauma surgeon, I need consultation from other subspecialists at times. If I have a patient with an arthritic hip and they also have a back problem, I refer to a spine surgeon and rely on the spine surgeon for advice. We talk back and forth and say, “Hey, what do you think? Is it the hip or the spine?” We put the history, physical exam, and tests together to decide if they need surgery and which should be done first. We are a team, and that’s a great term. That is why orthopaedic unity is so important.

Dr. Orfaly: Beyond the patient and the care received today, I know a passion of yours is orthopaedic research and OREF. Let’s relate that concept of the team and the orthopaedic family to how you approach OREF.

Dr. Kyle: Orthopaedic research is the engine that drives clinical practice. We have seen many advances in all areas of orthopaedics. Every subspecialty in orthopaedics has had major advances secondary to both clinical and basic research. The advances through research directly improve the care of our patients.

Orthopaedic research has allowed us to advance our profession and become more specialized. That is the reason we need unity and to work together. When I first started doing total knees, we had three sizes: small, medium, and large. Now I have 51 sizes, and I can custom-fit the majority of patients with off-the-shelf implants. The materials have changed, just like the materials in your car, TV, or dishwasher. The materials that we use and the designs of implants, materials, and instruments have advanced to the point that we can take much better care of every patient. That is all provided through research and also through education of younger researchers. We need to donate to research and education to help our new generation of orthopaedic surgeons and to keep our profession advancing in all fields.

Dr. Orfaly: When you talk about education, then obviously you can put your hat on as AAOS past president [regarding] AAOS’ importance to coordinate a lot of that activity.

Dr. Kyle: It’s amazing to me every time I come to a meeting, I learn a tremendous amount, and AAOS is a key organization that provides education, as are specialty societies. Education is the key. When I read AAOS Now, the Journal of Bone and Joint Surgery, and specialty society publications, there are scientific articles on research that feed into clinical practice. That’s the amalgamation of the information that advances our clinical practice results. Those articles support the evidence that we need to correctly treat our patients with new technology.

Dr. Orfaly: It’s great learning from your insights. You obviously have been a leader for so many years. I definitely appreciate you sitting down with me today, as well as your guidance of the profession and ultimately the care of our patients over so many years. Thank you very much, Dr. Kyle.

Dr. Kyle: I really appreciate the chance to be interviewed on this subject because, for me, orthopaedic unity really is a key to the preservation of our specialty of orthopaedics. We need to work together as a team to provide the best care for our patients. Thank you, Dr. Orfaly, for your work on AAOS Now and what you’re doing with it. It’s an excellent publication.

Robert M. Orfaly, MD, MBA, FAAOS, is a professor in the Department of Orthopaedics and Rehabilitation at Oregon Health and Science University. He is also the editor-in-chief of AAOS Now and chair of the AAOS Now Editorial Board.