Douglas Dirschl, MD, joined the University of Chicago in January 2013 to chair the newly created Department of Orthopaedic Surgery and Rehabilitation Medicine. A nationally recognized orthopaedic surgeon, administrator, teacher and researcher, he came to Chicago from the University of North Carolina, where he headed their orthopaedics department since 2003.
Dirschl is also a former president of the American Orthopaedic Association (AOA), and has seen significant advances in the field in his 20 years as a practicing surgeon. We spoke to him recently about how orthopaedics has changed, his research interests, and what he does when he’s not being a doctor.
What are the biggest changes in orthopaedics you’ve seen over the years?
Imaging and diagnostic capabilities have changed a lot over those 20 years. But the biggest changes are more related to how we treat things, big advances in what we can accomplish with arthroscopic care, for example. Twenty years ago, serious arthroscopic shoulder surgery was rare. Today, it’s commonplace. There have been advances in other minimally invasive techniques too: Minimally invasive joint replacement and fracture surgery, for example, none of which was really part of our care 20 years ago.
What has been behind the trend toward more minimally invasive surgery?
I think there are two reasons for that. It has enabled the transition from inpatient to outpatient care because people have less pain and can go home sooner after a procedure. But additionally it has been better biologically for the patient. The less harm we do with a big surgical dissection, the less harm we do to the body’s healing potential, whether it’s bone or soft tissues that are healing.
Take a fracture for instance. The traditional way of treating a fracture was to make a big surgical approach, strip the bone of all its soft tissue so you could see it clearly, and line up all the pieces so you could fix them with plates and screws. That was beautiful, it made beautiful X-rays and it was pretty good for stability, but in the wide exposure we actually could’ve created a situation where the bone was less likely to heal, because it had poor biology from what we had done in the surgery.
What are some of your areas of research on classifying fractures?
One aspect of it is in understanding the variability in the application of classification systems. Orthopedists have taken for granted the fact that if you devise a classification system, that means that every individual who applies it will get the same answer for the same set of images. But that’s not really true. We’ve done a lot of research looking into the factors that are responsible for that variability, with the goal of being able to create fracture classification systems that would perform with better reliability.
Another aspect of that research is on the advanced imaging portion, where we have made good progress in teaching the computer to be able to classify the fracture on an image for us. We’re training the computer to become more and more precise, with the goal of driving out completely the human variability in classifying the fracture.
Is that similar to how radiologists use advanced imaging to help diagnose cancer?
Exactly. There has been a great deal of this done in mammography, for example, in the detection of breast cancer. This is similar technologically. The image analysis, processing work and computer-based learning are very similar to that work. But we’re not using it to detect the fracture, we’re using it to characterize it so that we can better plan care. Because if we want to look at the outcomes of orthopedic care and we can’t agree on the input factors related to the fracture, then we have no ability to say much about the outcomes.
You’ve also served as the president of the American Orthopaedic Association. What part of that experience have you been able to implement here at the University of Chicago?
I had the opportunity to participate in the creation of their “Own the Bone” campaign, which is a program designed to help educate patients who have sustained fragility fractures and do what’s called secondary prevention. After an individual has had their first fragility fracture, you can prevent or lower the risk of their second fracture by educating them and treating them.
This program has been 10 years in the making, beginning with a multi-center clinical study on fragility fracture patients. Fragility fractures are defined by the National Osteoporosis Foundation as low energy fractures in anyone over 50 years of age. I had the opportunity to participate in the study, and then I’ve spent a great deal of time with the AOA helping to spearhead the effort and the program.
How big of an issue are fragility fractures?
They’re a huge issue. There are more than 2 million fragility fractures a year in this country. If you put that into perspective, that’s more than 11 times the annual incidence of breast cancer, more than 7 times the incidence of heart attacks, and more than 5 or 6 times the incidence of strokes. That’s a huge number. The problem is the difficulty in preventing these, because osteoporosis and low bone mass is a completely silent disease until you fracture, no one knows if they have it or they’re at risk. Since I’m an orthopedic surgeon and we treat patients with fractures, the perfect time for us to intervene with a patient is after they’ve had their first fracture. There’s a teachable moment there, and it’s a pretty good time to get them to understand that the fracture occurred because of osteoporosis or poor bone mass. Then we can treat them and try to prevent future fractures.
What are some of the programs you’re looking to build here as department chair?
One of the main reasons I came to the University of Chicago is that I think this institution is positioned better than anybody in the country to become a national leader in demonstrating the value of the care we provide. As health care is evolving and changing, insurers and the federal government and patients themselves are going to be searching more for value. Where’s the value in the care I provide? The profession of orthopedics has not done a good job of demonstrating this.
Given some of the research groups within the medical center, given the Booth School of Business and their interest in this, the school of economics and the school of public policy, I think we are perfectly positioned to take on a variety of research and clinical projects to become a national leader in demonstrating the value of musculoskeletal care. We have already developed some affiliations with the Harris School of Public Policy and the Booth School to work on this from an intellectual perspective, and we are working with two different research groups here on campus from a clinical perspective to start to assemble the financial data and the utility data to really do a number of projects to demonstrate value in orthopedic care. It would be my dream and my hope that this department becomes known nationally as a leader in this, that we have embedded in our educational programs.
Is that unique to have a clinical component with basic science, public policy, business and economics? That’s quite a combination.
It is unique, and I don’t know of any group in the country that has done it well. Again, that was one of the big draws to me here, because with the resources intellectually and otherwise at the University of Chicago, I think we’re perfectly positioned to do this unique thing.
What do you do when you’re not being an orthopedic surgeon?
(Laughs) What do I do in my spare time? My wife and I have three dogs, a German shepherd and two shih tzus, and we love them and they take up a lot of our time. My wife and I are also both endurance athletes, and we compete in triathlons. We love to train and do that. Additionally, I love to read stuff that maybe isn’t common for orthopedists. I like to read about cosmology and history, and I’m particularly intrigued by both the history of medicine and the history of the American Civil War.
To find out more about orthopedic surgery and rehabilitation options at the University of Chicago Medicine, visit uchospitals.edu.