Wilford K. Gibson, MD, FACS, FAAOS is a board-certified orthopedic surgeon and sports medicine specialist in private practice with Atlantic Orthopaedic Specialists. He practices at Sentara Leigh Hospital in Norfolk, Va. Dr. Gibson earned his medical degree from the Medical College of Virginia and then completed his internship while on commission with the U.S. Navy. Dr. Gibson completed his residency at the Naval Medical Center Portsmouth (Va.). He completed fellowship training in orthopedic trauma at Tampa (Fla.) General Hospital and fellowship training in hip reconstruction at Los Angeles County and Good Samaritan Hospitals. Dr. Gibson specializes in sports medicine, joint reconstruction and replacement and anterior hip replacement.
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Here is discusses his how practicing with the U.S. Navy has helped shape the way he views orthopedic care, his leadership positions with the Virginia Orthopaedic Society and the American Academy of Orthopaedic Surgeons and how hip surgery has evolved since he first began to practice.
Q: What attracted you the field of orthopedics?
Dr. Wilford K. Gibson: During high school and college I participated in sports and studied science. I was also mechanically inclined and spent many hours tinkering and repairing automobiles. I decided during college to merge my interests of science, mechanics and sports and pursue a career in medicine. During medical school, I was intrigued by surgery and the repair of the form and function of the human body. I decided during my final year to pursue orthopedics because of my desire to fix things and see the immediate results of my work. I was inspired by a clinical rotation during medical school, which gave me an opportunity to see and experience orthopedic surgery and the results. I was amazed by the tools and techniques and the camaraderie of the surgeons. I have not found anything else to be more rewarding than the restoration of function and relief of pain in a patient with an injury or disease that has taken their independence and enjoyment of life from them.
Q: How has your military background influenced the way you practice?
WG: I practiced in a variety of environments while serving in the U.S. Navy. I practiced at sea on ships and deployed to a variety of locations in the Mediterranean including Europe, North Africa, the Middle East and the Caribbean. I also practiced at a variety of military hospitals in the U.S., including a teaching hospital with orthopedic surgery residents. These experiences have given me wide exposure to a variety of techniques not routinely encountered in a civilian practice.
I believe seeing successful outcomes in austere environments where innovative techniques and skill trumped technology has provided me a depth of experience and the confidence to manage many orthopedic problems in a variety of acceptable ways. These techniques can be tailored to my patients' needs, optimizing the equipment and facilities available for superior results. My mission is the successful management of my patients' problems and returning them to optimum function with pain relief. I believe my military training and experience has focused me on the mission and value of my services more than the number or volume of surgeries performed.
Q: How do you feel your involvement with Virginia Orthopaedic Society and the American Academy of Orthopaedic Surgeons has contributed to your view of the field of orthopedic surgery?
WG: I have been a member of the Virginia Orthopaedic Society and the American Academy of Orthopaedic Surgeons since my earliest opportunity as a resident in orthopedic surgery. I have always felt a sense of purpose in my practice and a need to give back to the specialty that has made my career possible. The Virginia Orthopaedic Society has contributed to the improvement of the care of patients in Virginia since 1933 through annual educational programs and advocacy for patients and orthopedic surgeons in Virginia. It also fosters a collegial relationship of all orthopedic surgeons practicing in Virginia. I have participated as a member and have presented my research over several years. Later, I was asked to participate in leadership and served on the board for several years and subsequently as president of the VOS. It is important to the citizens of Virginia that we have a collegial professional organization in the state that advocates for the highest quality of musculoskeletal care.
Through my service at VOS I was recognized for my passion regarding education and advocacy and was elected to the board of councilors of the AAOS. The BOC is the deliberative body that represents the rank and file members of AAOS with representatives from each state, the U.S. territories, the military, regional societies and Canada. In the BOC I served on the state orthopaedic societies committee and was a founding member of the economics committee. I believe it was through my activity on the economics committee advocating for a level playing field for physicians and insurance companies by educating members and advocating for reform of the McCarran-Ferguson Act that I was recognized for leadership and asked to run for Secretary of the BOC.
The secretary position is an executive position of the BOC and includes a seat on the board of directors of AAOS. The AAOS is the premier orthopedic association in the world representing approximately 19,000 orthopedic surgeons in the U.S. and approximately 5,000 international members since 1933. As secretary I served on the AAOS council on research and quality and publications committee. As I rose to chair-elect of BOC I served on the council on education and AAOS political action committee. As the current chair of BOC, I serve on the council on advocacy and AAOS PAC. Besides serving on the AAOS BOD, I also oversee the National Orthopaedic Leadership Conference meeting in Washington D.C., and the AAOS Annual Fall meeting in Austin, Texas.
The AAOS champions the rights of all patients and advocates on behalf of patients and physicians to maintain the highest quality of musculoskeletal care. In my involvement in leadership of the VOS and AAOS I have gained a firsthand view of the field of orthopedic surgery and its profound worldwide impact on education, advocacy and quality. My primary lesson learned is that change is inevitable and desirable. Members must be engaged at the grass roots level to foster improvement in our profession and protection of our patients.
Q: How has reconstructive hip surgery changed since you first began to practice?
WG: Hip preservation and reconstruction has grown phenomenally since I first began practice. It should be noted that Sir John Charnley received the Nobel Prize for designing and bringing the first total hip replacement to the public in Great Britain in the 1970s. It quickly spread to the U.S. and was one of the most successful operations ever devised for pain relief and return of function in patients with arthritic hips. First generation techniques involved cementing implants in place. The cement was the "weak link" and the source of failure, but 80 percent of Charnel's hip replacements survived 20 years.
Improvements to eliminate cement failures led to press fit components with textured surfaces to facilitate in-growth of bone. With the elimination of cement and cement failures, the "weak link" became the high density polyethylene bearing surface. Recent improvement in bearings with ceramic and ultra-high molecular weight polyethylene have significantly reduced wear and many surgeons believe current hip replacements will likely last 30 years or possibly more.
Current research is engaged in identification of the cause of arthritis and the natural progression of the disease and ways to arrest or slow the progression. Certain hip shapes are more prone to develop impingement and wear and tear of the labrum or lip of cartilage surrounding the hip socket. Once this labrum is torn, the hip may become progressively arthritic. Attempts to change the shape of the hip socket or acetabulum may reduce the risk of impingement and labral tears leading to arthritis. Open or arthroscopic techniques to repair labral tears may prevent the development of arthritis in young patients. These are promising times! With the aging of the population and the growth of hip replacements there will be failures and the need for revision techniques and implants.
Many patients desire minimally invasive and muscle sparing techniques and the popular direct anterior hip replacement has grown significantly with hip replacements being performed routinely through an eight to 10 centimeter surgical incision. When hip replacements were originally performed the incision was approximately 20 centimeters and patients would be in the hospital two weeks. Current hospitalizations are usually three days with reports of some patients going home the day of surgery as outpatients. These are dramatic changes!
Q: As an orthopedic surgeon, what do you think is the biggest challenge you will face in the next five years?
WG: I believe the greatest challenge in the next five years will be the availability of specialized orthopedic care and access for patients. The orthopedic work force is aging and recent graduates of training programs are graduating with less experience and spend a year or two in additional fellowships learning skills in specific subspecialties of orthopedics. When young physicians start their practices they desire to limit their practice to their subspecialty. Mature orthopedic surgeons will retire and there will be a void covering all areas of orthopedics unless more physicians are trained in these areas.
The population is aging and increasingly active. The population is growing. More patients will have access under universal healthcare. My concern, and I believe our greatest challenge, is meeting the demand for orthopedic services with fewer physicians with more narrow scopes of practice. The challenge will require maximizing access with physician extenders and changing practice models with physicians taking on more supervisory roles. The challenge will be maintaining the world class quality and access we currently enjoy. I remain confident because we still have the best and brightest seeking careers in medicine and orthopedic surgery!
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