Joint Replacement

About the Program

The Virginia Tech Carilion (VTC) Adult Reconstructive Surgery Fellowship Program dates to the first total knee replacement done in southwest Virginia in 1973 by Dr. George D. Henning, who is still part of our non-operative faculty today. Since that time, the program expanded with the arrival of Dr. Joseph T. Moskal in 1988 as the first fellowship trained total joint and adult reconstructive surgeon. Under his direction, the adult reconstructive program was expanded to have a pre-operative joint school, standardized order sets, and a multi-disciplinary Total Joint Council. The total joint program at Carilion Clinic became the first JCAH accredited program for Total Hip and Knee Replacement in the state of Virginia in 2007.

Carilion Clinic is a Level I trauma center and a regional referral center for complex adult reconstructive problems including: primary and revision total knee and hip replacement surgery, peri-prosthetic fractures, angular deformities, and multi-ligament injuries to the knee. The total joint surgical volume has grown dramatically with the addition of Dr. John W. Mann in 2002 and Dr. Michael W. Wolfe in 2005 to the program. Most recently, Dr. Phillip J. Patterson joined our group in 2009. In 2011, 825 total knee replacements, 414 total hip replacements, and 148 total shoulder replacements were performed at the Carilion Clinic. Each faculty member was fellowship trained at top-notch programs: Cleveland Clinic, Insall, Scott Kelly Institute, Massachusetts General Hospital, and Charlotte Orthopaedics. The varying backgrounds and interests of each faculty member covers an exclusive niche of adult reconstructive surgery. Dr. Moskal has a defined interest the anterior approach to the hip and computer navigation surgery and is a national leader in this new surgical approach. Dr. Mann has a strong interest in computer navigation and its utilization in total knee replacement surgery. He is also very active with all types of knee ligament reconstructive surgery as part of the orthopedic trauma service. Dr. Wolfe has special training as a tumor expert and management of orthopedic infections. Dr. Patterson has a special interest in hip surgery to include hip arthroscopy and treatment of acetabular impingement. Multiple faculty members will allow the fellow to see varying clinical and surgical approaches to adult reconstructive problems and different orthopedic implants systems.

The Total Joint Replacement Council has worked as a multi-disciplinary team to improve clinical care and patient satisfaction. The Total Joint school and local outreach educational series "Points on Joints" has educated over 92% of our patients pre-operatively. Our pre-operative testing now identifies all patients who have nasal MRSA colonization and these patients are treated with Bactroban to help decrease MRSA infections. Our overall infection rate for Total Joint cases is well below the national average at 0.3%. We have worked diligently to decrease blood transfusion requirements after total joint replacement surgery recently utilizing Tranexamic Acid as a pharmacological adjunct bringing our transfusion rate to 0 transfusions over the last 3 months in all primary total knee and total hip cases. We have worked on a multi-modal pain management protocol to improve patient satisfaction. The anterior approach to the hip has been very successful with a significant reduction in pain medication requirements and decreasing hospital stay to 23-hour observation in 25% of our total hip replacement cases.

The Carilion Clinic Operating Room Committee allows for resident and fellow membership to mentor them in medical staff leadership. This committee is a key mechanism for our medical system to collaborate for improved patient care and outcomes. By employing JCAH Surgical Improvement criteria under the OR Committee’s oversight, the multiple areas of dramatic improvement have been achieved. The mortality rate for all surgical specialties has decreased from over 3% to 1.4% over the last 3 years. Surgical site infection rates have decreased from 4.2% to 2% when looking at all subspecialties and from 7% to 1.8% in general surgery patients. Surgical cost containment initiatives and efficiency protocols have saved over 3 million dollars in the past year just in decrease of orthopedic implant costs.

The total joint conference schedule offers attending-lead lectures for education of the adult reconstruction fellow. Journal Club literature reviews are held monthly. Clinical and basic science research opportunities are available through the clinical faculty and VTC.