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Orthopedics — Baylor St. Luke's Medical Center

Orthopedic surgical care at Baylor St. Luke’s Medical Center

A Message From Wilhelmina Barnhart Chair, Dr. Douglas Dirschl

The Musculoskeletal Service Line at Baylor St. Luke’s Medical Center is composed of dedicated medical and surgical specialists whose singular focus is treating patients with muscle, nerve, bone, and joint injuries or disorders through a highly collaborative approach, then returning them to their active lives as rapidly as possible. Our orthopedic surgeons are internationally renowned subspecialists in their fields who leverage the latest translational research and innovations in care while rigorously evaluating outcomes to constantly improve care.

Below, you will find descriptions of cutting-edge orthopedic surgical care provided at Baylor St. Luke’s Medical Center. All efforts focus on individualized patient treatment through collaborative, multidisciplinary teams of experts utilizing innovative techniques and protocols that translate to improved patient outcomes.

A critical feature that distinguishes the orthopedic surgical services at Baylor St. Luke’s Medical Center from others locally and nationally is our unrelenting effort to improve through innovation and thoughtful incorporation of translational scientific discoveries, often by our own Baylor College of Medicine investigators within the Center for Skeletal Medicine and Biology as well as the Rolanette and Berdon Lawrence Bone Disease Program of Texas. Ongoing work related to the determination of the mechanisms of bone development, repair, and aging is just one example.

Orthopedic surgery faculty, as well as those within the Musculoskeletal Service Line at Baylor St. Luke’s Medical Center, are national thought leaders who publish and lecture extensively, educating not only those in training but also their colleagues in practice around the world. They are the best, and they are here for you.

Sincerely,
Douglas Dirschl, MD
Wilhelmina Barnhart Chair
Joseph Barnhart Department of Orthopedic Surgery
Baylor College of Medicine

Douglas Dirschl, MD

Same-day hip and knee replacements show fewer complications, better outcomes, and higher patient satisfaction

Same-day joint replacement procedures have increased considerably in recent years. Advances in surgical techniques, improved pain management protocols, technological advancements, and the desire to enhance patient experience and satisfaction are all reasons behind this trend. 

Hip and knee arthroplasty experts at Baylor College of Medicine are combining the latest innovations and technologies with tried-and-true techniques that have made hip and knee replacements successful procedures. With minimally invasive techniques such as partial knee replacements and anterior-approach hip replacements, patients are experiencing a more rapid recovery. 

And with technologies such as navigation and robotic-assisted surgery, which enable visualization of the ultimate outcome prior to the actual surgery, orthopedic surgeons can bring new levels of precision to primary arthroplasty and complex and revision cases.  

Moreover, recent data show fewer complications and better outcomes when joint replacement patients don’t remain in the hospital post-surgery. While there is no cookie-cutter approach for all patients, the majority of hip and knee replacement patients now undergo surgery in an outpatient setting. Patients get to go home the same day and sleep that night in their own bed with the comforts of home, ultimately increasing patient satisfaction without sacrificing safety. 

“It’s important to take a personalized approach and understand where each patient is coming from, tackle their concerns, and offer a more tailored procedure that meets their individual needs. This leads to a smoother recovery following surgery,” noted David Martin, M.D., one of Baylor Medicine’s orthopedic surgeons specializing in revision total knee and hip replacement, minimally invasive joint replacement, and arthritis and joint reconstruction.

Minimally invasive, endoscopic procedure offers better outcomes than traditional surgery for patients with upper extremity injuries and conditions

Patients who suffer from neurogenic thoracic outlet syndrome (NTOS), a painful condition resulting from compression of the nerves, arteries, and veins in the lower neck and upper chest area, can find relief through a minimally invasive surgical treatment that is performed endoscopically rather than through more traditional approaches. 

Traditionally NTOS has been treated with open surgery that entails large incisions, a harder recovery, and more complications, notes Adil Ahmed, M.D., assistant professor at Baylor College of Medicine, who specializes in the unique endoscopic approach. The minimally invasive surgery offers patients a quicker and safer recovery, with smaller incisions that are more aesthetically pleasing and have lower complications.

Dr. Ahmed also specializes in peripheral nerve and brachial plexus surgery, offering treatment with nerve repair, nerve grafting, nerve transfers, and tendon transfers for the shoulder. The latter procedure allows patients with irreparable rotator cuff tears or prior failed repair to preserve the joint and restore the function of the lost rotator cuff without having to undergo a shoulder replacement.

Baylor College of Medicine upper extremity specialists possess extensive knowledge and expertise in comprehensive care for other upper extremity injuries and disorders, including: hand and wrist injuries, fracture fixation, shoulder and elbow joint replacement, shoulder arthroscopy for rotator cuff and labral injury, elbow arthroscopy, management of elbow ligament injury and instability, forearm and hand trauma, nerve injury and repair of peripheral nerves and the brachial plexus, and microsurgery.

Upper Extremity Surgery

Expertise and sub-specialty training in various disciplines are necessary for providing comprehensive care for upper extremity injuries and disorders. Baylor College of Medicine upper extremity specialists are required to possess extensive knowledge and expertise in various areas including hand and wrist injuries, fracture fixation, shoulder and elbow joint replacement, shoulder arthroscopy for rotator cuff and labral injury, elbow arthroscopy, management of elbow ligament injury and instability, forearm and hand trauma, nerve injury and repair of peripheral nerves and the brachial plexus, as well as microsurgery.

Adil Ahmed, M.D., assistant professor at Baylor College of Medicine, further offers a unique, minimally invasive surgical treatment for neurogenic thoracic outlet syndrome (NTOS) that is performed endoscopically. “Traditionally NTOS has been treated with large open surgery that’s quite morbid for patients,” explains Dr. Ahmed, “this means large incisions, harder recovery, and more complications. By offering this surgery endoscopically, patients have a quicker and safer recovery, with smaller incisions that are more aesthetically pleasing and have lower complications.”

Additionally, Dr. Ahmed is an expert in peripheral nerve and brachial plexus surgery, offering treatment with nerve repair, nerve grafting, nerve transfers, and tendon transfers. 

Dr. Ahmed also performs tendon transfers for the shoulder. “Patients with irreparable rotator cuff tears or prior failed repair often only have two options: shoulder replacement or tendon transfer. Many patients are too young for a shoulder replacement, but a tendon transfer allows them to preserve the joint and restore the function from the lost rotator cuff.”

Fragility fracture and clinical translational research

Orthopedic trauma care

Baylor College of Medicine orthopedic trauma subspecialists are available 24 hours a day, seven days a week, 365 days a year, providing treatment for patients presenting to Baylor St. Luke’s Medical Center, as well as other public and private facilities within the Texas Medical Center that lack this level of expertise. Our highly integrated, multidisciplinary Fragility Fracture team at Baylor St. Luke’s includes specialists in geriatrics, physical medicine and rehabilitation, and other subspecialties. These experts provide individualized care for fragility fracture patients, emphasizing minimally invasive fracture stabilization and post-operative mobilization as a means to avoid known complications and return individuals to their normal lives.

Pictured (from Left to Right): Omar Atassi, MD, John Dawson, MD, and Christopher Perkins, MD

Age-related bone fragility

The integration of translational research and innovation into orthopedic clinical care, as seen in the Fragility Fracture Program, sets Baylor St. Luke’s Medical Center apart as a top-tier academic health care institution. Dr. Florent Elefteriou, associate director of the Center for Skeletal Medicine and Biology at Baylor, investigates the complex interactions between the brain and bone cells. His laboratory studies the contribution of autonomic nerves to the progressive bone loss experienced in everyone as a function of aging, beginning in the third decade of life. Through targeted studies, they have been able to demonstrate that drugs, safely used for the management of cardiovascular diseases, have a protective effect against the bone fragility associated with aging. These findings have direct implications in the care of elderly fracture patients.

Sports medicine and sports surgery

Baylor College of Medicine sports medicine experts at Baylor St. Luke’s Medical Center are leaders in developing surgical techniques and performing complex reconstructive knee, shoulder, and elbow surgeries. Dr. Bruce Moseley and Dr. Phillip Williams perform high volumes of common sports procedures, such as anterior cruciate ligament (ACL) reconstructions, rotator cuff repairs, arthroscopic shoulder stabilizations, sports injury repairs of the elbow, and open shoulder surgeries, including anatomic total shoulder arthroplasties and reverse shoulder replacements. Our team offers special expertise on complex and revision surgeries, such as revision ligament reconstructions in the knee, meniscus allograft transplants, articular cartilage restorations, hip and knee arthroscopies, osteotomies of the knee, Latarjet and superior capsule reconstructions in the shoulder, ulnar collateral ligament (Tommy John) elbow surgeries, and revision shoulder arthroplasties.

Our sports medicine specialists are dedicated to developing and applying new technology in an effort to optimize patient/athlete outcomes with the goal of getting people back to a high level of activity. "In the field of sports medicine, embracing innovative surgical techniques and implementing emerging trends in orthobiologics is crucial for enhancing athlete recovery and performance. Our approach includes advanced procedures and personalized care strategies to improve results and expedite the return to sport or desired activity," says Williams.

Orthopedic surgeons offer recipe for successful same-day hip and knee replacements

In recent years, there has been a considerable rise in the number of same-day joint replacement procedures. This trend can be attributed to several factors, including advances in surgical techniques, improved pain management protocols, technological advancements, and the desire to enhance patient experience and satisfaction. Recent data indicates, in fact, that complications are fewer and outcomes are better if most joint replacement patients don’t remain in the hospital after surgery.

The Baylor College of Medicine hip and knee arthroplasty experts are combining the latest of these innovations and technologies with the tried-and-true techniques that have made hip and knee replacements such successful procedures. With minimally invasive techniques, such as partial knee replacements and anterior-approach hip replacements, patients are experiencing a more rapid recovery from their prior activities. Additionally, by utilizing technologies such as navigation and robotic-assisted surgery, our team can bring new levels of precision to primary arthroplasty and complex and revision cases. 

“One of the benefits to robotic-assisted surgery is that we are able to see the ultimate outcome before even starting the surgery,” says David Martin, M.D., one of Baylor Medicine’s orthopedic surgeons specializing in revision total knee and hip replacement, minimally invasive joint replacement, and arthritis and joint reconstruction.

The majority of our hip and knee replacement patients are enjoying the benefits of having their surgery done in an outpatient setting. By aligning innovative surgical techniques and technology with our patient’s goals, Baylor Medicine Orthopedics is getting patients back to their quality of life prior to being hindered by arthritis. 

“The benefits of outpatient surgery are that patients get to go home the same day and sleep that night in their own bed with the comforts of home, ultimately increasing patient satisfaction without sacrificing safety,” states Dr. Martin. 

Martin also emphasizes that there is no cookie-cutter approach for all patients. “It’s important to take a personalized approach and understand where each patient is coming from, tackle their concerns, and offer a more tailored procedure that meets their individual needs. This leads to a smoother recovery following surgery.”

Clinicians working together to advance care

By leveraging the medical expertise within Baylor Medicine, as well as working seamlessly with specialized therapists and allied healthcare providers, we are able to ease pain, restore function, and quickly return our patients to their active lives.

Comprehensive services

  • Bone Health and Osteoporosis 

  • Certified Hand Therapy

  • Concussion Evaluation & Management

  • Diagnostic Modalities — X-Ray, Fluoroscopy, Ultrasound, CT, and MRI

  • Orthopedic & Sports Physical Therapy — Blood Flow Restriction, Dry Needling, Active Release, and Graston Technique

  • Performance Enhancement & Nutrition

  • Podiatric Medicine

  • Regenerative Medicine — Platelet-Rich Plasma, Stem Cells, and Bone Marrow

 

Surgical specialties

  • Foot & Ankle

  • Hand & Upper Extremity

  • Hip & Knee Preservation and Replacement

  • Orthopedic Oncology

  • Orthopedic Sports Medicine

  • Orthopedic Spine 

  • Orthopedic Trauma

  • Outpatient and Narcotic-Free Joint Replacement

  • Robotic-Assisted Joint Replacement

Pictured: Dr. Florent Elefteriou

Meet Dr. Ahmed

Dr. Ahmed is dual fellowship trained in both Hand and Microsurgery and Shoulder and Elbow surgery. He pursued extensive sub-specialty training in the United States, across Europe, and Australia to hone a unique skill set, offering complete care for all upper extremity conditions and injuries. His areas of expertise include wrist and hand injuries and shoulder and elbow replacement, including complex revisions for cases with bone loss, instability, infection, and fracture. He is also proficient with tendon transfers for irreparable rotator cuff tears (lower trapezius transfer, latissimus dorsi transfer, pectoralis major transfer) and performs scapular stabilization surgery for winging and dyskinesia. “Given newer techniques we can perform same-day surgeries while maintaining excellent outcomes and recovery,” states Dr. Ahmed. Dr. Ahmed also performs tendon transfers for the shoulder. “Patients with irreparable rotator cuff tears or prior failed repair often only have two options: shoulder replacement or tendon transfer. Many patients are too young for a shoulder replacement, but a tendon transfer allows them to preserve the joint and restore the function from the lost rotator cuff.”

Additionally, Dr. Ahmed is a referral source for other orthopedic surgeons and specializes in managing challenging problems and revisions of prior failed surgeries. Dr. Ahmed says the key to successful treatment and after surgery is understanding the patient as a whole, not solely on what their complaint is. “What does their social support look like? What does ‘normal’ look like for them? After all, patient education is vital to their success long term,” says Dr. Ahmed.

Meet Dr. Cahill

Dr. Catherine Cahill, explains how she is able to perform same-day hip and knee replacements and why most of his patients do not require strong pain medications, such as opioids, during recovery.

“There is a recipe for success to go home on the same day of the surgery while still maintaining the same recovery criteria as those who require overnight hospitalization or longer. What I do is facilitate patients achieving those milestones a lot quicker,” said Cahill, who is also a volunteer professor in the Joseph Barnhart Department of Orthopedic Surgery and participates in ongoing research at Baylor.

Why is diversity for women and minorities important in orthopedic surgery?

Orthopedic surgery is the least diverse medical specialty in terms of both gender and those under-represented in medicine (URM). A diverse orthopedic workforce is a key component in addressing health disparities and inequities, and Baylor Medicine is doing its part to help train and diversify the next generation of healthcare leaders.

In 2013, the percentage of women residents in orthopedic surgery was 14%. Despite current medical school classes being split evenly by sex, the percentage of women in orthopedic surgery residencies has remained fairly constant (between 13% and 15%) for the past decade. In 2016, 86.6% of orthopedic surgeons reported as Caucasian, 6.7% reported as Asian, 1.7% reported as Hispanic or Latino, 1.5% reported as African American, 1.2% reported as multiracial, 1.7% reported as other, and 0.4% reported as Native American. The U.S. Census Bureau predicts that Asians, African Americans, Hispanics, and Latinos will soon compose 30% of the population, and by 2042, will be greater than 50%. Minority physicians continue to provide the majority of care for underserved and non-English speaking populations.

The orthopedic surgery residency program at Baylor College of Medicine continues to break barriers within the specialty, with about 30 percent of its residents identifying as female. Dr. Nicole Montgomery has helped spearhead these efforts to recruit, retain, and educate women in the residency program. While the American Academy of Orthopaedic Surgeons aims to be more intentional about recruiting diverse surgeons, the field still has strides to make. 

“Now that we have more women expanding the field, we’re seeing a domino effect of being able to inspire more women to enter (it), to reach out to more students who are female and break down those stereotypes,” said third-year resident, Dr. Olivia A. Barron. “Just because we use drills and tools that have been historically associated as ‘man tools,’ (it) doesn’t mean that women can’t step into the operating room and do the same thing.”

While the U.S. population has become more diverse, the orthopedic surgery workforce has not kept pace. Efforts will need to be made at the departmental, institutional, and national organizational levels to improve these conditions.

The women in the Baylor orthopedic team developed a sense of bravery and courage in order to pursue something they love. Dorothy Beauvais, assistant professor of orthopedic surgery, encourages women to do what they want without letting appearances deter them.

“(Underrepresented populations) face difficulty finding someone to take interest in them. When we can relate to others, we build a relationship. The more diverse the specialty becomes, the more we can attract others and relate to them,” Beauvais said. “Many medical students are also deterred from surgery because of the physical demands of the specialty.”