Colin M. Kingston, MD, FAAOS, CAQSM, is a board-certified orthopedic surgeon and sports medicine physician with Tidewater Orthopedics. Dr. Kingston serves as the medical director of the Orthopaedic Hospital at Sentara CarePlex in Hampton, Va. He earned his medical degree from the Uniformed Services University of the Health Services in Bethesda, Md., and completed his residency at the Uniformed Services Health Consortium in San Antonio.
Dr. Kingston discusses his experience as a flight surgeon, how computer-assisted surgery is revolutionizing orthopedic surgery and the most difficult cases he has encountered during his career.
Q: Why did you choose to become an orthopedic surgeon?
Dr. Colin Kingston: I didn't know I wanted to do orthopedic surgery until my third year of medical school. I originally wanted to be a pediatric surgeon, as I wanted to be like Dr. C. Everett Koop who was the Surgeon General when I was contemplating a career in medicine. However, I found out that being a pediatric surgeon was extremely taxing on me emotionally. I will never forget on my third year rotation when a child died from an inoperable tumor and having to discuss this with the patient's young parents.
It wasn't until I did my rotation in orthopedic surgery that I realized this would be my passion and career endeavor. A CMSgt in the USAF could not go for walks with his grandchild for the fear he would not make it back due to severe arthritis in his knees. I saw my first total knee replacement and thought it was the most barbaric surgery I had ever seen with saws, hammers, chisels , something more apt for a carpenter wood shop! Then I saw how well the CMSgt was doing, he was tearfully grateful for his knee replacements and for the first time he could walk with his grandchild without pain. I had found my career choice and the fact that orthopedic surgeons provide definitive care for athletes was an added bonus.
Q: How has your experience as a flight surgeon influenced the way you practice orthopedics today?
CK: Flight surgeons are general medical officers in the military that specialize in aerospace medicine and preventative care. Often times they are utilized as the medical officer on duty (MOD) and work in small emergency rooms. They are the only physicians that put their lives in their patients' hands when they fly in the back seat of a high performance jet or helicopter. I was a flight surgeon for four years prior to doing my orthopedic residency; this would comprise of a small cadre of orthopedic surgeons who have done the same.
I went to a mishap prevention course and was tasked to be the medical investigator on several aircraft mishaps. A common denominator of all mishaps appears to be a series of errors, usually not just one, that leads to an airplane crashing and potential loss of life. Aircrew safety and mishap prevention protocols have been implemented in the Air Force for years and continue to improve. This philosophical approach to utilizing checklists, preventing unimportant distractions that would deter from the mission and pre-flight as well post-flight debriefings are essential to the prevention of mishaps. This systematic approach has helped me tremendously in assuring that patients receive the best possible care with lowering the likelihood of a mishap or complication. Implementing this approach in medicine has been extremely challenging and is one of the reasons I became the medical director of the Orthopaedic Hospital at Sentara CarePlex. We have one of the lowest complications to care ratio in the region, but it is unfortunately not zero.
Q: How will computer assisted surgery continue to change the field of orthopedics?
CK: Computer-assisted surgery has already changed the field of orthopedics. It enhances the precision of the surgery and provides better real time three-dimensional analysis of a patient's patho-anatomy and poor function. A surgeon can assess component position of an implant and the impact it will have on returning near normal kinematics to a joint BEFORE a cut is even made.
Overall, it allows for better reproducibility and implant position that should enhance the longevity and function of the implant. CAS opens the door for better programming, enhanced performance of joint replacements and eventual better OR efficiency as technology improves. As the number of orthopedic surgeons is expected to decrease by 25 percent and as the need for joint replacement doubles in the next decade, CAS will be a major part of meeting that demand especially as outcomes data becomes more transparent.
Q: What are a few of the most challenging cases you have encountered in your career?
CK: The most challenging cases I have performed are revision surgeries and tumor surgeries. When I was chief resident, I had to resect a rare malignant tumor and replace the patient's distal femur with a specialized prosthesis, all the while ensuring that clear margins had been obtained. For a primary total knee replacement, I had a patient with a 27 degree valgus deformity in extension that went into 14 degrees of varus deformity in flexion. If I had based my implant position on a still image such as a CT scan or MRI, the functional outcome for this patient would have been less than ideal. CAS was essential to not only giving this patient a straight leg, but one that did not vary by more than one to two degrees from the same plane through a full moving arc of motion.
For shoulder instability, the most difficult case was a patient who had recurrent dislocations despite three previous operations by other orthopedic surgeons. This patient's glenoid was underdeveloped, which was better appreciated on a 3D CT scan. The glenoid had to be reconstructed using allograft to provide stability.
Q: What advice do you have for orthopedic surgeons just beginning to practice?
CK: The advice I can give for orthopedic surgeons just starting out is to discover what you are good at and avoid the temptation of doing surgery outside of your expertise. If there is any doubt, one should always consult with a more experienced orthopedic surgeon prior to any surgical intervention. However, the best advice I could give is always be compassionate to your patients, as almost every patient that seeks orthopedic care is in some degree of pain.
More Articles on Sports Medicine:
Dr. Geoffrey Westrich: 4 Points on Hip & Knee Revision Surgery
Improving Quality of Life & Understanding the Changes Ahead in Orthopedics: Q&A With Dr. David Mack of North Cypress Sports Medicine Center
The Evolving Field of Hand Surgery: Q&A With Dr. Samuel Kline of Atlantic Orthopaedic Specialists