Orthopedics chief at Highland discusses new job, joint replacement, changes in pain management protocols and how artificial intelligence may impact procedures
By Chris Motola
Q: How long have you been chief of orthopedics at Highland Hospital?
A: I’ve been the chief for a couple of months now, so it’s relatively recent.
Q: How’s the transition going? Were you always aiming for the job?
A: I wasn’t aiming for it, but I’d been involved in some of the quality initiatives prior to it, so that’s something I’d been working on for awhile. And then the person who was the previous chief, Catherine Humphrey, had another opportunity to run the trauma service over at our other hospital, so there was an opportunity for someone else to be involved. And that’s how I became involved.
Q: What are you duties now and how are you dividing your time between administration and your clinical practice?
A: There are a couple of different duties. One is quality assurance. So a big part of being a chief is just overseeing that you’re providing a high quality of care to patients. This involves making sure that we have appropriate quality assurance meetings, to go over cases that were challenging to see if there’s anything we could learn or change our processes to produce better outcomes. Also, I meet with representatives from other areas of medicine and nursing and administration to just see if we’re up-to-date and evidence-based in our practices and make sure we’re providing optimal care to our patients. Another aspect of being the chief is credentialing, so that’s making sure that the physicians practicing in our department are appropriately credentialed, and reviewing new physicians as they come in and make sure they have appropriate credentialing. Additionally, we oversee the operating room and make sure that people have appropriate operating room time to get their cases done as best we can and to treat the many patients who want to be treated here. Those really are the main aspects.
Q: Do you handle any academic issues?
A: Yes, we have residents here. We teach residents at Highland. We give lectures throughout the year. I also do research at the university, mostly joint replacement outcomes and joint replacement infections. Those are really my two main areas. But I’m pretty involved in the academic side of things as well.
Q: Your personal specialty is joint replacement?
A: Yup, I’m an orthopedic surgeon who specializes in hip and knee replacements. That’s the bulk of my practice. I also do hip fractures and geriatric traumas at times as well.
Q: Joint replacement seems like a specialty that sees a lot of advances as of late. As chief of orthopedics, do you get to screen new developments, techniques, devices?
A: Yeah, there are a number of exciting things that have been going on in joint replacement in recent years. One area we’re doing better in is on the pre-operative side, making sure patients are as optimized as possible coming into surgery. We’ve increased our patient education a lot so people are well prepared to understand what their surgery will entail, what their recovery will entail. I think this helps monitor people’s expectations and set those expectations appropriately. The rehabilitation after knee replacement is critically important and just getting patients to realize what they need to do after surgery is something we’ve been getting better at. Additionally, we’ve changed our pain management protocols over the years, so now most of our pain management is done through regional anesthesia, usually a spinal anesthetic with a local block. And this has really reduced opiate consumption and feeling sick after surgery. And it’s allowed them to mobilize a lot quicker with physical therapy. So we get people back up shortly after surgery, get them walking right away, and then most of the patients can leave the hospital the next day, which is a big change from before. It allows people to recover at home, out of the hospital environment. It’s better for them to be in a more familiar environment. There are also advances in minimally invasive approaches, which we’ve been doing in more recent years, and just being more precise with our surgeries.
Q: Have the implants changed much?
A: Most of the implants haven’t changed as much. There have been some changes in the plastics over the last 20 years that have made the longevity of the joint replacements substantially better. So that’s one thing that’s been a big change that’s allowed us to offer the surgery to younger patients.
Q: How young are we talking?
A: It depends on what’s going on with the joint, but people over 50, 55 probably won’t need a new one. Under that age, there’s a chance you might need another one down the road. But we do joint replacements for people in their 40s and even 30s when we need to, where in the past that may have been an issue.
Q: What’s the typical lifespan of the joint replacement?
A: About 80% make it to 20 years.
Q: I’m assuming activity levels affect that.
A: Yeah, activity levels probably play a role. We don’t encourage patients to do high-impact activities on them, but people can usually get back to most activities, even things like tennis and skiing — those types of activities. There definitely is a correlation to how much you use to the joint to its wearing out.
Q: Do you think AI will have impacts on your specialty in the near future?
A: There’s been a lot of talk about how artificial intelligence will impact what we do. And that’s something that will probably increase over time. It will probably impact a bunch of different areas. Data is very important in healthcare in general, both in clinical records and notes, which will provide a lot of opportunities to identify ways to do things better and allow research in areas that we haven’t been able to before. So it will expand what we can do with data we’re already collecting. Another aspect is image-recognition, templating implants, those kinds of things can potentially give us the technology we didn’t have before. And they may be able to be integrated into robotic surgery at some point. All of this is experimental, but at some point they’ll probably be integrated into our practice in some manner.
Lifelines
Name: Benjamin F. Ricciardi, M.D.
Position: Chief of orthopedics at Highland Hospital
Hometown: Ridgewood, New Jersey
Education: Weill Cornell Medical College (medical degree); residency in orthopedic surgery and a fellowship in adult reconstruction and joint replacement at the Hospital for Special Surgery in New York City; European fellowship in hip reconstruction with the ME Müller Foundation.
Affiliations: Highland Hospital, Strong Memorial, University of Rochester Medical Center
Organizations: American Academy of Orthopedic Surgeons, American Association of Hip and Knee Surgeons, American Orthopedic Association
Family: Significant other, one child
Hobbies: Skiing, reading, traveling