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CCJR Founder A. Seth Greenwald Reflects on Joint Replacement Advancements

In January, The Hip Society and The Knee Society in partnership signed an agreement to acquire Current Concepts in Joint Replacement® (CCJR®). For nearly 40 years, CCJR has educated thousands of joint replacement surgeons around the world, giving them a platform to debate surgical techniques and discuss trending topics of the day—conversations that have advanced orthopedics. The bi-annual conference will hold its Spring Meeting from May 8-11 in Cleveland, Ohio, and is expected to host surgeons, device companies and contract manufacturers.

CCJR’s success is attributed to Founder and Course Director A. Seth Greenwald, DPhil(Oxon), a scientist and educator who, after a successful career in aeronautics, stumbled into orthopedics and made a lasting mark on the industry. Dr. Greenwald is Director of Current Concepts Institute, which organizes CCJR, and Orthopaedic Research Laboratories, a testing firm.

Dr. Greenwald told us that the recent acquisition is not a signal that he’s retiring. Still, we thought the announcement made for appropriate timing to ask him his thoughts on the joint replacement industry, as well as the longevity of his success in orthopedics.

What developments, trends or changes in joint replacement excite you the most? 

        Seth Greenwald  
        Dr. A. Seth Greenwald  

Dr. Greenwald: What I see happening is the extension of the longevity of contemporary medical devices. Why it goes hand and hand with what is happening in our society is, people are living much longer than they used to. The span of inclusion for who can benefit from an orthopedic procedure, be it an arthroscopic debridement of loose bodies of soft tissue or correcting the imbalance of the hip and knee, is being extended to include younger patients and older patients. The big challenge in front of us is to make sure that design evolutions keep in step with this, and that the devices will ultimately outlive the patients that they’re implanted into, regardless of their age.

If you think about the evolution of joint replacement, we’ve gone from cemented to cementless in the hip, and now we’re doing the same thing for the knee. The shoulder is becoming a growing source for joint replacement, not to mention the joints in the hand and the ankle. Orthopedics as a subspecialty is getting more and more sophisticated. We’re entering into an era of robotics, getting the components in optimally. I don’t think we’ll ever replace the surgeon, but it’s going to make the surgeon’s life easier and make the average surgeons better surgeons in the next five or six years.

What developments, trends or changes in joint replacement are of the most concern to you?

Dr. Greenwald: There are a couple of things.

One has to recognize that just like in life, in any occupation there is a spectrum of ability. You go from less than average to average to people who are such experts that they’re naturals. The reason for all education and hands-on education is to improve the average and make the average better.

The second compelling concern is, who is going to pay for all of this? The bottom line is that as subspecialties develop, the cost has to be kept in line—not without the prospect of unreasonable profit—but if it’s too highly priced, people don’t have access to it. I suspect that government is becoming more involved in the responsibility of healthcare for the nation. CMS is experimenting and implementing bundled payment programs, where one price will be inclusive of all the pre-surgical and gradual care of a patient, right through to the endpoint of joint replacement and postoperative rehabilitation and care. How is that going to manifest itself within the spectrum of vested interests? The government has a vested interest; private insurers have a vested interest and corporations that need healthcare and want to provide healthcare for their employees have a vested interest. With all of that, an optimal outcome hopefully in time and turn will emerge. The biggest questions are how to provide access to healthcare for every citizen, and how are we going to pay for it?

As a researcher at heart, is there a technology not yet on the market that you can’t wait to see one day?

Dr. Greenwald: When I got involved in orthopedics, my problem at the beginning was totally biological. I was trying to identify the weight-bearing surfaces of a human hip joint and compare them to sites of cartilage breakdown, which were attributed to be arthritic or, generally speaking, degenerative joint disease. I expect that we’re going to step back into biological solutions for the arthritic process. There are many attempts out there, some of which I think are bogus—by simple injections of stem cells, you can make the process disappear. It’s going to take a lot of hard basic work from a benchtop and also from patient related and retrieved data on the arthritic conditions.

I don’t want to talk myself out of the need for implants, because they have been a solution to a very serious problem afflicting millions of people in this country and around the world, but I also think when ends finally meet, we will come to understand the biology of degenerative joint disease and the reparative process that might assist with recovery. That’s how I got into orthopedics in the first place—perhaps naively at the time—nevertheless, I think that remains and should remain a goal.

How far in the future will that be?

Dr. Greenwald: A decade from now we will be there.

As someone who has successfully built companies from the ground up, what traits have you relied upon time and again?

Dr. Greenwald: First of all, you have to like yourself. More than that, you have to like the folks around you who you interact with. We all have pressures; we all have foibles; we all have defects. Try to seek out the best of what an individual is and then call that individual your friend if your interests coincide.

I like people; I look for the best in what they’ve got—everybody has a story. I love people of passion, and I can appreciate the tension of a surgeon walking into an operating room and having to drop a knife.

Dr. William Harris, a well-known hip surgeon in Boston, once said, when you’re teaching residents and you’re teaching fellows, you must take them to the point where they’re standing in the operating room all by themselves, and they’re called upon to make the decisions. You go up to a situation where you have to do something, but you really don’t know what to do; you have to make the decision that is in the best interest of the patient. CT scans and MRIs don’t always give you the precise information that you see when the scalpel is going through the skin and the soft tissue, and you’re looking at the pathology. It can be a tough call, and if you’re experience hasn’t prepared you for it, you have to reason through it in a very short moment of time and hopefully make the right decision in the interest of the patient.

I’ve thought about that a lot. You have to move forward. Just as you open, you have to close.

What advice would you offer a young person entering an orthopedic company?

Dr. Greenwald: Everything is so diverse today that within a given company, you can seek freedom to try a number of different things. If it really is where your interest lies, you’ll find something that drives your passion. And once you find something that drives your passion, go at it. You have to go for it and give it all you’ve got—mentally and emotionally and intellectually.

You want to surround yourself with people who have values that you appreciate, but have knowledge you can gain from.

Carolyn LaWell
is ORTHOWORLD's Chief Content Officer.