Anthony Miniaci, MD, is a staff physician for the Cleveland Clinic's Center for Sports Health. Hailing from Toronto, Canada, Dr. Miniaci served as a professor at the University of Toronto and has been a consultant for the National Hockey League Players Association. Here, he shares his thoughts on advances in minimally invasive surgery and the importance of preserving patients' anatomy in joint surgery.
Note: Responses have been lightly edited for style and clarity
Question: What trends are you seeing right now in outpatient orthopedics?
Dr. Anthony Miniaci: We're moving to a lot of arthroscopy being done as outpatient, patients are recovering and going home much quicker. I do a lot of outpatient or overnight surgery for patients that require partial or total joint replacements.
One of the areas of interest for me is shoulder replacements. We've been doing shoulder replacements for a number of years with patients going home the same day.
Q: What innovations are being made in implants for orthopedic procedures?
AM: One of the major advances is trying to recreate patients' own anatomy so their function and range of motion and longevity of the implant is improved. In the shoulder, we've learned recently the humeral (head) side has a more ovoid shape as opposed to a sphere, and by doing an inlay glenoid procedure, we can give patients a better range of motion and improve function so they can get back to doing their normal activities.
Q: What changes do you expect to see in outpatient orthopedic procedures in the future?
AM: We're trying to achieve a few things: First, we want to respect the patient's anatomy when operating. By doing that, we improve their function and we reduce the stress on our implants so they can potentially last longer. The second thing we're focusing on is minimally invasive surgery. In addition to using smaller incisions, we're preserving bone and more of the patient's soft tissue, maintaining as much of the normal anatomy as possible. Thirdly, with advanced navigation and arthroplasty techniques, a lot of procedures are going to move to the outpatient setting where patients can go home the same day.
Q: You've spoken about advancements with total shoulder replacements. What strides have been made for total knee procedures?
AM: The same thing is happening for the knee as has been done for the shoulder --- we have partial replacements for the knee, too. You can replace small areas of the knee, as well as half and full knee replacements, and all of these are being done with less invasive techniques. The trend is to try to reconstruct the patients' anatomy as accurately as possible.
Q: How can surgeons prepare themselves and their patients when they take cases outpatient?
AM: The most important thing is taking a team approach and the patient is a big part of that team. The surgeon can help them understand what the process is, and in turn take good care of them by using alternate medications and getting them away from the opioids.
Q: Any final thoughts you'd like to share?
AM: Partial knee replacements over the years have expanded, especially when treating younger patients where we're trying to prolong their abilities to do their normal activities without replacing their full joints. Some of these concepts of partial replacements for joint problems are going to expand as we go forward. Also, for shoulder replacements, by restoring the patient's own functional anatomy, we've seen better results than the standard total shoulder replacements that we've been doing for years.