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a previous replacement joint. The models are created using individual patients’ CT scans or MRI or both and sterilizable materials. “In the operating room, we have the model on the table right next to the patient. That helps us to identify optimal implant placement or screw fixation,” Dr. Couch says. Arthroplasty and cancer care Mayo Clinic commonly treats patients with bony defects due to cancer. Radiation and medical oncologists meet regularly with orthopedic surgeons to discuss patients and plan treatment. Surgical reconstruction of the hip or knee may precede or follow radiation treatment. “We typically make these decisions based on the tumor type and location, but sometimes on a case-by-case basis,” Dr. Couch says. “Sometimes having chemotherapy or radiation therapy upfront will reduce the size of the tumor, facilitate removal and optimize the maintenance of function.” Historically, patients having total hip arthroplasty after pelvic radiation experienced high rates of implant loosening when traditional uncemented acetabular components were used. But Mayo Clinic orthopedic researchers have found that 100% of modern, porous titanium components remained radiologically well fixed 10 years after implantation in patients having total hip arthroplasty after pelvic radiation. As described in the Journal of Arthroplasty, the mean overall pelvic radiation dose for the 33 patients in the study exceeded the radiation threshold for dose-related bone effects. A separate study, described in The Journal of Bone and Joint Surgery, found that for patients with periacetabular metastatic disease, acetabular reconstruction using highly porous tantalum components provided a more durable construction and fewer complications compared with procedures using the cemented technique. “Advances in medical care and radiotherapy mean that more cancer patients are living longer,” Dr. Couch says. “Restoring patients’ joints allows them to return to walking soon after surgery. The goal is for these patients to spend the remainder of their lives doing the things they want to do, relatively pain-free.” For more information Wellings EP, et al. Contemporary porous titanium acetabular components for total hip arthroplasty after pelvic radiation. Journal of Arthroplasty. 2021;36:1714. Houdek MT, et al. Comparison of porous tantalum acetabular implants and Harrington reconstruction for metastatic disease of the acetabulum. The Journal of Bone and Joint Surgery. 2020;102:1239. Sports Analytics: Identifying At-Risk Athletes Before Injuries Occur Sports analytics can provide information about not only an athlete’s likely future performance but also that individual’s risk of sports injury. Mayo Clinic orthopedic surgeons work closely with professional athletes to discern how to avoid those risks and how to best treat injuries when they occur. One example of this is Mayo Clinic’s relationship with the Minnesota Twins. Among other projects, Mayo specialists are working with the major league baseball team on the prevention of injuries of the medial ulnar collateral ligament of the elbow, also known as Tommy John injuries (Figure, see page 5). “A Tommy John injury is one of the most common and significant injuries in baseball. It often requires surgery with 12 to 18 months until full recovery,” says Christopher L. Camp, M.D., a sports medicine orthopedic surgeon at Mayo Clinic in Rochester, Minnesota, and medical director and director of high performance of the Twins. “Everyone involved with a team has a vested interest in identifying individuals who may be at risk of a Tommy John injury before it happens.” The potential benefits of these efforts extend beyond professional sports. “We can eventually use this information to help college, high school and youth athletes,” Dr. Camp says. “More Tommy John injuries actually occur in nonprofessional athletes than professionals. Right now, we have a lot more data on professional athletes. But we want to take advantage of that information and apply it to a larger population.” Multidisciplinary and holistic approach Mayo Clinic’s multidisciplinary approach Cory G. Couch, M.D. MAYO CLINIC | OrthopedicSurgeryUpdate 5 Rafael J. Sierra, M.D. Aaron J. Krych, M.D. Young Adult Hip and Pelvic Conditions: Comprehensive Approach for Optimal Care Figure. Surgical photograph shows a completed reconstruction of the medial ulnar collateral ligament, also known as Tommy John surgery. to patient care is also typical of professional athletic organizations. “Pro teams have a lot of high-caliber medical and performance specialists, including athletic trainers, physical and massage therapists, strength conditioning coaches, sports psychologists, and nutritionists, as well as physicians,” Dr. Camp says. “The goal of any multidisciplinary approach is to coordinate all these efforts and care not only for injured players but also for healthy players, to help them achieve optimal performance.” That team approach is key to tackling issues such as a Tommy John injury. “The rates of Tommy John injury are rising rapidly. It’s a complex problem that will probably have relatively complex solutions,” Dr. Camp says. “There’s no single cause. We have to take a holistic approach, looking at players’ health, at how they perform on the field and what they’ve done in the off-season.” Risk factors include throwing too many pitches, throwing too hard
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