Week 1: Jumping right in

I had the advantage of having a previous connection with my mentor, as our lab group collaborates with Dr. Bostrom and has Skype meetings with his research group twice a week. I went to meet with Dr. Bostrom after getting my NYP ID Monday morning, and he immediately handed me scrubs and took me straight to the OR. I was able to observe several total hip replacements and a total knee replacement. Even though I had an idea of what to expect going in, it was still amazing to see them literally hammering away with so much force.

Tuesday I went with Dr. Bostrom to Helen Hayes Hospital where he saw patients. It was interesting to see the variation between patients who are very similar radiographically, both pre- and post-operatively. Patients that are almost identical on paper may have very different ideas about when they need to have surgery, and have very different recovery experiences, in terms of pain and/or time required. There was no way to predict a patient’s response.

Wednesday was another clinic day, this time at HSS. I did get to see an interesting case where a patient who had had his knee replaced reported blisters down his leg and on his foot. He sent in pictures on Monday that didn’t look great, but weren’t particularly worrisome. He sent in new pictures on Wednesday, however, and the blisters had swelled dramatically and were constantly leaking. He was brought to the hospital to be admitted, and the doctors are trying to identify what is going on.

Thursday we were back in the OR, this time for several revision surgeries to repair problems such as loosening due to osteolysis and to remove osteophytes that had formed. I was surprised by how closely the surgeons work with vendors when performing revisions. A vendor was in the OR helping to identify the proper tools used for each step, how to use them, and how to know when the implant was inserted all the way. It was a completely different side of things that I had not expected, and it was interesting to see.

Today during clinic I had the opportunity to see a patient who had fallen down an elevator shaft ~50 feet (5 stories) and underwent multiple surgeries as a result. Instead of just a total hip or total knee replacement he also had a total femur replacement. Everything from his hip to his knee was an implant. It was amazing to see how positive his disposition was. When we went into the room he showed off his stomach, after undergoing surgery for what I understand was a massive hernia. Even after everything he went through, and is still going through, he had a smile on his face the whole time.

I have also been able to briefly discuss possible research projects with Dr. Bostrom. On the more clinical side of things, he has been looking into the effects of using a modular distal fixation hip implant for revisions and the clinical outcomes associated with them. This would be more of a retrospective analysis. On the more research-based side of things he wants to investigate the effects of PTH treatment on the histomorphometry of different regions of the femoral neck (sides in tension vs. compression, etc). Femoral necks will be taken from patients during hip arthroplasties and analyzed. I’m excited to get into the research aspects of immersion now that I have gotten a better feel for the day-to-day schedule.