This first week in NYC I got settled in at the Hospital for Special Surgery. We were required to obtain an extra ID badge, fill out forms to be cleared for the OR, and to meet with the director of Biomechanics, Dr. Wright. My PhD advisor, Dr. van der Meulen, is on sabbatical this year in NYC, so I was also able to meet all the people who are collaborators with her and who are people I might work with in the future.
On Tuesday, I was able to meet with Dr. Padgett, my mentor for the summer. He performs many total and partial arthroplasties of the hip, knee, and shoulder. During our meeting, he presented me with a particular patient's chart and x-ray scans, which were severely misaligned due to a growth plate abnormality. His right knee was in dire need for a complete makeover, as the joint appeared rotated probably at least 30 degrees. After we briefly talked discussed the case, we walked over to a patient room and actually met with the patient for his follow-up visit, a year after surgery! I was able to see Dr. Padgett compare the old and new x-rays, examine the patient's mobility, and discuss his pain levels and problems. It was really interesting to learn how Dr. Padgett worked with the patient, his wife, and an engineer to design an implant that perfectly fit his needs. Afterward, Dr. Padgett showed me the patient's "pain level" charts, which showed great improvement from before surgery to after. He really made an impact on the patient's quality of life, who before surgery would not want to even walk down the driveway to the mailbox. We briefly discussed my summer project. Dr. Padgett directed me to Joe Lipman, the director of device development at HSS and also an engineer. For my summer project, Dr. Padgett wants me to learn about custom made implants, and present a particular patient's case in detail, with my inputs.
Also this week I attended the required bioethics training, which covered many of the topics we had to read for the CITI training. Also, I attended a number of lab meetings, including Dr. Boskey's lab meeting, Dr. Bostrom's lab meeting, and the TERR meeting, all of which gave me an idea of the particular research projects that are being conducted in these groups.
On Thursday, I attended grand rounds for total arthroplasty. A fellow presented some recent cases, and the attendings, fellows, and residents present discussed the outcomes. Throughout the meeting, Dr. Bostrom (who was leading), would challenge residents to answer specific questions about the chosen course of action. It was very interesting to learn about how bone scans after a total arthroplasty can indicate where the device is probably loose. This area shows up as "hot" on the scan, and can be a very non-invasive method for diagnosing problems with implants. It was also interesting to hear how doctors handle patient cases differently, such as the difference in material for hip implants with age. Some doctors use metal on metal in as young as 45 years of age, whereas some believed that was too young. Later, we had a presentation that discussed how patients at higher volume centers have better outcomes, and the reasons behind this were speculated and examined through data presentation.
From Thursday afternoon to evening, I was invited to go sailing with Dr. Bostrom's group for their yearly event at the Larchmont Sailing club. We sailed for over 4 hours in the afternoon and had a very formal and fancy dinner later in a private room at the club. It was fun to spend more time with the people in the lab and get to know Dr. Bostrom better.
Lastly, on Friday I also attended another lab meeting, usually held by Dr. Padgett but this week was held by Dr. Wright. He went around the table and discussed issues each person was having, and touched base with their progress. I learned that the lab has quite a few projects going on, from spine fusions, hip and knee simulators, and new mobile bearing hip replacement projects. I was interested to learn that the lab often has cadaveric samples to work with, which is of great advantage. Often a sheep or cow is used for a spinal sample, but they do not experience the same loads as quadrapods such as humans do, and so the outcomes are never exactly the same.