The Hughston Clinic’s sports medicine focus led to world-class orthopedic center

Jack C. Hughston, MD, fostered sports medicine as his clinic grew into a full-service practice.

The achievements of the late orthopedic surgeon Jack C. Hughston, MD, are inextricably entwined with the historic accomplishments of The Hughston Clinic that he established in 1949, exemplifying what is possible when original ideas for orthopedic care and research are actualized by individuals with vision and drive.

Those familiar with its reputation said the clinic, based in Columbus, Ga., mainly gained worldwide respect as a private pioneering orthopedic center after Hughston almost single-handedly elevated sports medicine to a level of acceptance enjoyed by only a few orthopedic subspecialties at the time.

“He was really one of the founders and fathers of sports medicine,” Hughston Clinic President John I. Waldrop, MD, told Orthopedics Today.

This year The Hughston Clinic celebrates its 60th anniversary and recently treated its one-millionth patient. It has evolved into a multi-subspecialty orthopedic practice focused on spine, knees, shoulders, hands, elbows, feet and ankles, total joint replacement, trauma, physical therapy, rehabilitation, and more.

Today, 19 orthopedic surgeons of The Hughston Clinic serve nine locations in Georgia and Alabama. In 1968, the Hughston Foundation, a nonprofit institution was founded and dedicated to research, education and training.

A physician-owned hospital was added to the Hughston enterprise in 2008, creating a complete vertically integrated health system for orthopedic care, Waldrop said.

Hughston was reportedly the first team physician for the Auburn University Tiger football team. He is shown with Auburn University’s former head football coach “Shug” Jordan (right), who was named national coach of the year in 1957. Images: The Hughston Clinic

Treating athletes

Initially, Hughston provided Friday night medical coverage at high school football games in the 1950s. His training in pediatric orthopedics and work with children suffering from polio spawned his interest in treating young athletes, sources said.

His team affiliations included serving as team physician for the Auburn University Tigers football team. Today many physicians on staff are team doctors, according to Champ L. Baker Jr., MD, FACS, who is the team physician for athletics at Columbia State University.

Hughston’s original practice was established to care for student athletes by observation, examination and treatment, either surgical or nonsurgical, Baker said. “Today’s mission statement is virtually the same,” he added. “Our goal is excellence in patient care.”

Pioneering areas

The Hughston Clinic pioneered many key areas in sports medicine. Hughston’s work with dental organizations is reportedly why football players today wear mouthpieces. He also sought to ban dangerous blocking in football, according to Baker.

Hughston helped establish the American Orthopaedic Society for Sports Medicine (AOSSM) and was its third president from 1974 to 1975. He also was the founding editor of the American Journal of Sports Medicine, holding the position from 1972 to 1990.

According to Bruce Reider, MD, the journal’s current editor, Hughston once housed the journal’s editorial office in his Columbus office, contributing the Hughston Foundation’s resources to keep it operational.

Knee focus

Hughston devised “the knee sheet,” a widely used and frequently published knee injury classification tool on ACL injuries. He was among the first to document patellar subluxations and dislocations in athletes, said Baker, a past AOSSM president.

Jack C. Hughston, MD, is often called the father of sports medicine. He is shown here examining a football player’s leg.

“The Hughston Clinic remains a world-class organization,” said Carlton G. Savory, MD, FACS, who joined the practice in 1988. He said there was no question it was where he wanted to work after interviewing with Hughston.

Savory’s adult reconstruction training dovetailed with Hughston’s vision to expand the clinic in response to practice diversification and advances in orthopedics.

“We have since evolved into a full-service orthopedic clinic,” focusing on multi-subspecialty needs through the past 15 years as part of our long-term plan, Savory said.

Expansion effort

With a high volume of procedures, Hughston’s joint reconstruction service remains traditional, eschewing trendy techniques that lack scientific evidence. “We have tried to fine tune and develop a center of excellence with respect to joint replacement, our clinical pathways and how we manage joint replacement patients,” Savory said.

Covering high school and college football games was a practice Hughston, founder of The Hughston Clinic, established early on. He believed much could be learned about knee injury mechanisms by witnessing them on the field. Today, many orthopedic surgeons at the clinic are team physicians.

“We are on the leading edge of total joint replacement and spine care,” Waldrop added.

Baker said he thinks J. Kenneth Burkus, MD, is doing breakthrough work in the treatment of spinal problems. Involved in key multicenter FDA studies, Burkus’ decision to join The Hughston Clinic revolved around the fact it conducted forward-looking clinical research which allowed him to participate in basic science investigations.

Burkus and other spine specialists have delved into emerging areas of spine care, such as bone-grafting technologies and lumbar and cervical total disc arthroplasty.

In establishing the foundation, Hughston had the vision to equip it with medical illustrators, videographers and medical writers, Burkus said. “Jack had the foresight to have these positions filled before we really needed them.”

Philosophy

Another Hughston philosophy: Patients deserve to be treated with respect and equality and given quality care.

“He drove that into all of us from day one,” Waldrop said.

Orthopedic surgeons the world over have come to The Hughston Clinic seeking ideas for new approaches to clinical care, research and education.

“The Hughston Clinic and Foundation are internationally known and I am proud to have been part of its history,” said Giancarlo Puddu, MD, member of the Orthopaedics Today Europe Editorial Board.

An influential, long-term professional and personal relationship between Hughston and Puddu developed after Puddu and his wife visited Hughston in 1975, Puddu said, “My approach to the knee and to the patients was forever changed for the better.”

The Hughston Clinic celebrates its 60th anniversary this year. It has always focused on research and education. Pictured in this 1985 photo with Hughston (left) are Glenn C. Terry, MD, who is still at the clinic, and Patrick A. Smith, MD, in fellowship training, and a visiting German physician.

Hospital ownership

The Hughston Sports Medicine Hospital, a unique concept at the time, was launched in 1985. Last year the clinic opened The Jack Hughston Memorial Hospital, a physician-owned hospital, in Phenix City, Ala. (See Orthopedics Today January 2009, page 18). “We are proving our model to be correct because we can and have done it better than a lot of places,” Waldrop explained.

The clinic has survived organizational challenges, especially after Hughston died in 2004, but is prepared to face changes in reimbursement, technology and the delivery of health care, according to the staff. Waldrop credited Chief Executive Officer Usman B. Mirza and Chief Operating Officer Mark Baker for positioning the organization for the future.

“We are absolutely dedicated to making sure The Hughston Clinic will be around for another 60 years,” Savory said.

James R. Andrews, MD, Hughston’s partner for several years during the 70s and 80s, established successful sports medicine centers in Alabama and Florida following The Hughston Clinic model.

He told Orthopedics Today, “It makes me feel good to be connected to and have a good relationship with The Hughston Clinic.” Fellows from both groups will hold a combined educational program this year.

“The relationship with Dr. Hughston and what I learned from him has helped me with my career. When I left there in 1986 it was like leaving a father. I owe everything to Dr. Hughston,” Andrews said.

For more information:

• James R. Andrews, MD, can be reached at Andrews Sports Medicine and Orthopaedic Center, 805 St. Vincent Drive, Suite 100, Birmingham, AL 35205; 205-939-3699; e-mail: ljohnson@asmi.org. Champ L. Baker Jr., MD, FACS, J. Kenneth Burkus, MD, Carlton G. Savory, MD, and John I. Waldrop, MD can be reached at The Hughston Clinic P.C., 6262 Veterans Parkway, Columbus, GA 31908; 706-324-6661; e-mail: cbaker@hughston.com; jkb66@knology.com; cgsavory@aol.com. Giancarlo Puddu, MD, can be reached at Clinica Valle, Via G. De Notaris, 2B, 00197 Rome, Italy; 39-06-855-2982; e-mail: giapu@tin.it.

References:

• www.hughston.com
• www.jackhughstonmemorialhospital.com