Keith Berend, MD, an orthopedic surgeon at the New Albany, Ohio-based Joint Implant Surgeons, discusses joint procedures in the United States.
Question: Could you speak a bit about your involvement with the charity Operation Walk USA?
Dr. Keith Berend: My partner Dr. Adolph Lombardi and I worked through cofounding an organization called Operation Joint Implant, which was the predecessor to the national organization Operation Walk USA. I had done Operation Walk Mooresville, which is an organization out of Indianapolis, with my brother Mike Berend, where we went to Guatemala and Nicaragua to provide free hip and knee care to needy folks in Central America. We brought Dr. Lombardi with us, and he has been participating with us for several years. When we returned from one of those trips Dr Lombardi said: "why can't we do this for people in the U.S.?" We first went through the process of defining what "need" is — there's a lot of access to care within the United States, access to government subsidized care through Medicaid and other programs. We found the true need was in the "working poor": the people who don't have the money to afford expensive healthcare, but who make too much money to qualify for significant government assistance. We created Operation Joint Implant as a local program, where we provided free hip and knee care to people in need, here in New Albany. When Dr. Lombardi became president of the The Hip Society, his vision was to develop a nationwide program and to expand Operation Joint Implant into what is now Operation Walk USA, and I was happy and excited to participate in its launch.
Q: Are you working on any research projects?
KB: We're constantly working on research projects. We've got everything from FDA trials to long-term follow-up of patient outcomes. Our biggest efforts currently are focused on outpatient joint replacement research: we've been looking at our readmission rate and looking at the things that have been going on with CMS' bundled payments. We saw one recent publication that showed that bundles, and moving to a support system care pathway, reduced readmission rates from 16 percent to 9 percent. It was our belief that our admission rate or readmission rate in our ambulatory surgery center was much lower than that. We wanted to look at our acute complication and readmission rates, looking at transfers to the ER or subsequent hospitals — and we found that, when we looked at the more than 3,200 outpatient joint replacements that we've done, we had a transfer of care rate of only 0.3 percent. We feel like that's an incredibly low number, and it proves that outpatient joint replacement is very safe, if less than half a percent of people required acute care following a joint replacement at our ASC.
Q: How has joint surgery changed since you graduated from medical school?
KB: There's a pattern of rapid recovery, leading to short stay, leading to outpatient — that's certainly the most profound thing. Looking back at the care of the patient 10 years ago, 20 years ago, and seeing how long they were in the hospital and all of the things we did to patients when they were coming in for an elective, quality of life procedure — it's very remarkable to me how we've moved into an era where outpatient joint replacement is becoming the norm. I think, in my own practice, I've also seen the use of partial knee replacement go from 6 percent to becoming more than half of the knees that I do. I think that we're going to see that as a trend that's going to ramp up nationwide, and worldwide. We're in an era where the old dogma that all total knees do well is being questioned. We're seeing people really believe that we can do a partial knee, but take care of the whole problem. I see the trend, although it's been slow to date, and I think we're really at a turning point in terms of worldwide acceptance of partial knee replacement not being an alternative to total knee replacement, but the correct operation when we shouldn't be doing a total knee replacement. It is clear that total knee arthroplasty carries a higher risk of complication and even death, thus partial knee replacement is not only a faster recovery with better function than TKA, but is also safer. We don’t need to over treat people with total knee arthroplasty when partial can do the job.
Learn more from Dr. Berend at the 15th Annual Spine, Orthopedic & Pain Management-Driven ASC Conference + The Future of Spine in June 2017! Click here for more information.
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