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Harry E. Rubash, MD
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Second Session
Moderator: Harry E. Rubash, MD
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| Howard B. Yeon, MD, JD |
Chris Chiodo, MD |
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Asset Protection for Orthopaedic Surgeons
Howard B. Yeon, MD, JD
Discussor: Chris Chiodo, MD
Advisor: James H. Herndon, MD, MBA
Dr. Yeon presented his original work that combined his dual training
in medicine and law. He reviewed existing forms of asset protection and
the methods suitable for use by the majority of Orthopaedic surgeons. The
goal was to assess whether asset protection is a practical complement to
medical malpractice insurance for most Orthopaedic surgeons. He consulted
practicing attorneys in Massachusetts, New York, New Jersey, Connecticut,
and Florida to assess the current utilization of asset protection devices. He
explained how the current insurance and legal systems coincide to increase
the cost of medical malpractice settlements, at the peril of the practicing
surgeon.
He concluded that asset protection is a practical means of supplementing
medical malpractice insurance and that broad adoption of asset protection
as an alternative o medical malpractice insurance may result in inadequate
funds available to injured patients. The discussor, Dr. Chiodo, and the
moderator, Dr. Rubash, both applauded his work and suggested that Dr. Yeon
bring his ground-breaking work to a broader audience.
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| Alexander P. Sah, MD |
Thomas S. Thornhill, MD |
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Dislocation Rate after Conversion of Hip Hemiarthroplasty to THA – Greater than First-time Revision THA
Alexander P. Sah, MD
Discussor: Thomas S. Thornhill, MD
Advisor: Daniel Estok, MD
Revision hip arthroplasty continues to have 3 to 5 times greater dislocation
rates than primary hip replacement. The purpose of Dr. Sah’s study was
to determine whether conversion surgery carries the same or greater dislocation
risk than revision total hip replacement. Dr. Sah summarized a retrospective
series of conversion total hips, from hemiarthroplasties performed
for fracture. He found a significantly higher rate of subsequent dislocation
in these patients compared to primary THA and compared to hips revised for
other reasons. He postulated that the relative stability of the very large endo
head means that hemiarthroplasty patients become accustomed to a much
larger stable range than is possible after a total hip replacement. Several
arthroplasty surgeons in the audience added that for this and other reasons,
they are increasingly likely to perform primary THA for their patients who
present with femoral neck fracture.
Dr. Thornhill pointed out that Dr. Sah’s work was an important piece in a
long-standing debate on the role of hemiarthroplasty today. He then inquired
as to whether Dr. Sah’s data could shed any more light on the subject of the
proper treatment of femoral neck fractures. Dr. Sah responded that this was
another piece of evidence that for younger patients (less than 80 years old) a
THA may be a more viable alternative. He emphasized that femoral downsizing
would still be an important parameter to keep in mind.
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