Q&A: Research program provides answers to challenges in adult reconstruction surgery
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Key takeaways:
- The Cleveland Clinic Adult Reconstruction Research Program aims to provide answers for challenges in adult reconstruction surgery.
- Establishing a research program is a full-time job that requires hours of work.
More than 15 years ago, Wael K. Barsoum, MD, started the Cleveland Clinic Adult Reconstruction Research Program with the goal of finding solutions to daily challenges in adult reconstruction surgery.
Since its inception, the research program has grown into a large and cohesive group that has published more than 100 papers a year during the last 5 years on a range of topics in adult reconstruction surgery.
To learn more about the Cleveland Clinic Adult Reconstruction Research Program and its goals and achievements, Healio spoke with Nicolas S. Piuzzi, MD, director of the Cleveland Clinic Adult Reconstruction Research Program and co-director of the Musculoskeletal Research Center.
Healio: What are the goals of the Cleveland Clinic Adult Reconstruction Research Program?
Piuzzi: At the Cleveland Clinic, we have one of the largest, most complex practices of joint reconstruction nationwide. We have an active and large training program, both for residents and fellows, and we have a lot of partners who face challenging cases day after day. Oftentimes, we find that we don’t have solutions or answers to things that happen in our daily life practice. What we do in the Cleveland Clinic Adult Reconstruction Research Program is try to answer the current challenges in joint replacement: infection; complications; pain and functional improvement, as assessed by patient-reported outcomes or satisfaction after surgery; joint preservation; the use of technology or robotics; the use of orthobiologics and all aspects of our practice that remain major challenges.
The key to the program is having a strong team in which each team member is recognized and able to execute tasks to the best of their ability as they advance in their careers. Everybody is challenging themselves and, in the end, the group as a whole advances. This is all tied intrinsically with the mission of the Cleveland Clinic: caring for life, researching for health and educating those who serve.
Healio: What are the clinical benefits of having a research program in your institution?
Piuzzi: For us, one of the main benefits is that we have quality control on everything we do. We get to scrutinize our practice firsthand. For example, we collect baseline data with a 98% completion rate and 1-year data with about an 80% completion rate. That means, for most of our patients, we know how they did through their surgeries. From a research perspective, it allows us to improve and see what things are working, what things are not working and which patients we need to help differently. Clinically, it helps us evaluate what it is that we’re doing. We can make changes in real time to improve the care that we provide to patients and, oftentimes for things that we don’t have answers to, we are trying to create paths to provide answers. For example, we have more than 15 ongoing clinical trials, many of which are for infection. We’re trying to develop and work with different collaborators to advance patient care in a way that we hope will become the standard of care in how we take care of, for example, periprosthetic joint infection.
Healio: What has the Cleveland Clinic Adult Reconstruction Program achieved so far?
Piuzzi: We’ve done a lot. One of the main things that we’ve achieved is we have helped train a lot of orthopedists internally and indirectly through our publications. It’s a trickle down and butterfly effect. But if you ask me specifically which spaces we’ve contributed to the most, we’ve done a lot of headway in phenotyping patients before surgery, risk stratification and the management of multiple risk factors before joint replacement, both in the primary and in the revision setting. This helps guide patient counseling, the indication for surgery and how to optimize patients through the surgery episode. We’ve also made a lot of contributions in the treatment of infections around joint replacement. We’ve made headway on the use of complex reconstructive techniques to treat failed joint replacements and, more recently in the last 5 years, in the use of robotics and technology across our field.
Healio: What areas of research does the Cleveland Clinic Adult Reconstruction Program hope to cover in the future?
Piuzzi: Infection remains a major topic and a major challenge that we need to continue to work at, and we need to try to make a big change in practice. It’s a great need for our patients and it’s a great need for our field. The second topic is truly personalized medicine. When we think of joint replacements, it should not be thought of as a cookie-cutter approach where everybody gets the same treatment. We need to bring all data that we’re collecting back to the patient in a way that we can get them to be able to undergo surgery through a safer path and ensure better outcomes. We need to even the field to make safer treatment available to everyone, so that every patient getting a joint replacement is able to have a more reliable outcome. Going forward, we have a duty to our patients to do more in how we answer critical gaps because there are going to be more patients requiring this surgery and requiring musculoskeletal care. We’ll have to be able to live up to that.
Healio: How has the Cleveland Clinic Adult Reconstruction Research Program helped advance your practice?
Piuzzi: It’s helped me think of each patient differently. Not from a personal connection, but from a professional perspective, it gave me different tools on how to better help patients. The way research has helped me is to put experience-driven approaches into a data-driven approach, and that’s the passion that drives what I do. I want to be able to have an evidence-based practice where we have true numbers and where we have true data that guide everything that we do. If we think about the tools that we have available now in 2023, they are not the same tools that we had when we trained as orthopedic surgeons, and data analytics have changed. Now we are in a position where we can truly make a dent and make this a reality. I know what the percentage risk of readmission is for every patient that I do surgery on. I know what the chances are of a patient going home or benefiting from surgery at 1 year after surgery. Those things help you think of surgery and patient care differently because then you can sit down with a patient, you can lay out all the options and you can empower them to make decisions based on hard facts. That’s an empowerment that we need to give back to our patients, and it’s a tool that we need to give to our field and to ourselves so that we can practice better.
Healio: What advice do you have for researchers who want to build a research program?
Piuzzi: When you teach, there are two people learning. When you do research, it’s the same way. You learn, you benefit and you grow tremendously. The benefit goes to yourself, to your partners, to your team but also to your institution and to the field and helps build that legacy. As physicians, we are continuously teaching, we’re continuously educating our colleagues, we educate ourselves and, as we get educated, we educate our patients. Education is the key aspect of what we do. In something like research, you just have to go ahead and do it and know that there is a place for everybody. There’s nothing that is too small and nothing that is too big.
Of course, there’s going to be institutions that are going to be better suited for research. I know that I’m privileged for being at the Cleveland Clinic and I have a fertile environment to achieve what we do. That’s unique and there are not many places like that in the world. But anybody can collaborate with us. We live in a world of connections now where, even if you don’t have the researchers, somebody else will have them. But know that it’s a full-time job. It requires a lot of energy, a lot of time and a team. It’s not something that you can only do in your spare time. It’s something that will require hours of your day and attention, and you’ll have to make it a priority. But, in the end, the benefit hopefully would outlast our lifetime as surgeons. That helps make your little contribution into the larger good and common good of our field and our patients.
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