Week 5: Green in a sea of blue

This week I had the opportunity to join Jason and shadow in HSS with Dr. Michael Cross, watching two total hip replacements, three total knee replacements, and one revision knee surgery. I have been looking forward to having exposure to total hip and knee arthoplasty surgeries due to several courses in biomechanics I was able to take in undergrad. I was impressed by the smooth workflow in each of the primary joint replacement surgeries; it was abundantly clear that everything was routine. However, I found the materials of the implants and the potential consequences for the patient to be the most interesting aspect. Among choices for potential implant materials, the decision to choose either oxinium or cobalt chrome for the material of the femoral head exemplifies the balance between cost and benefits to the patient. Oxinium is oxidized zirconium produced by Smith and Nephew. It is a metallic alloy with a ceramic surface which provides wear resistance without the traditional disadvantage of brittleness observed in ceramic materials. These benefits are particularly important for younger or active patients, but come at a higher cost. Thus, the attending physician balances the potential benefits with increased cost when choosing the material for the femoral head.

During this week I also continued shadowing in vascular surgery, seeing endovascular abdominal aortic aneurysm repair, superior femoral artery angiography/plasty/stent placement, and more. Among the vascular procedures I shadowed this week, the excision and ligation of an aneurysm in the greater saphenous vein was particularly interesting. The patient presented with a very large venous aneurysm, which Dr. Connolly chose to address in an open procedure. Venous aneurysms are much less frequent relative to arterial aneurysms, and this particular aneurysm was enormous relative to the size of the vein. Overall, the procedure was quick, and would have been unremarkable if not for the size and placement of the aneurysm. Finally, I've obtained access to pre- and post-op CT images for my upcoming project on the impact of branched and fenestrated stents on renal artery morphology.