By: 22 April 2020
Surgeon Focus – Mohit Bhandari

Mohit Bhandari currently serves as Professor and Academic Head of the Division of Orthopaedic Surgery at McMaster University, Ontario. He is the Associate Chair of Research in the Department of Surgery and holds a Canada Research Chair in Evidence-Based Orthopaedics, the only chair of its kind. He received his Masters Degree in Health Research Methodology from McMaster University and his PhD Degree from Goteborg University, in Sweden. He is recognised as a global leader in evidence-based surgery and orthopaedic research, receiving some of the fields’ highest awards, including the Royal College of Physicians and Surgeons Medal, the Edouard Samson Award, and the Kappa Delta Award. He has been acknowledged among the top 10 most cited orthopaedic fracture surgeons in the world and has received Canada’s highest honour for his lifetime achievements, The Order of Canada.


OPN: As a specialist in orthopaedic surgery, could you tell us more about your experience and training background in this field?

MB: The road to a career as a surgeon scientist spanned approximately 20 years of post secondary school education. This training included a degree in medicine, a specialty training in orthopaedic surgery, a Master’s of Clinical Epidemiology (MSc), a Doctorate in Science (PhD), and two years of sub-speciality training in fracture care (one year in Minneapolis, MN, and one year in Los Angeles, CA).


OPN: What drove you to choose surgery as a career – and orthopaedic surgery in particular?

MB: I remember the exact moment I decided I wanted to pursue the specialty of orthopaedic surgery. It was 1991, at St Michael’s Hospital during my first elective experience in orthopaedic surgery with Professor Robin Richards. So much of what we end up choosing at this early stage is often strongly influenced, not as much by the content of the field, but the role models who represent this field. Robin Richards was a masterful surgeon, a scientific mind, a creative leader and a superb educator. I wanted, at that moment, to be just like him. Sadly, I don’t think I ever told him about his important role in my decision until 2018, when he visited McMaster University as a visiting professor.


OPN: What’s the best part of your job?

MB: This one is easy. The diversity of amazing people at all levels. The surgical scientist career path has led me to pursue many global opportunities, many countries visited and most importantly, collaborations with many surgeons and healthcare providers. There is so much to learn by simply changing the lens in which we view the field of orthopaedic surgery. For instance, the priorities and challenges in India and Africa are uniquely different from those in North America. For me, the most exciting part of the research globally, is solving questions that matter to everyone. These questions are, by definition, simple ones.


OPN: … and the worst?

MB: Collaborating globally comes with one big cost. Time away from home and time in airports, airplanes and taxis. While I absolutely love the interactions globally, the 110,000 miles of flights each year, the tens of thousands of hours in airports (waiting), and thousands of hours in a taxi are not my favourite. I remember getting a number of congratulations some years ago for becoming a ‘Million Miler’ with Air Canada. I actually felt I deserved condolences. That said, it’s still worth every bit of travel to get to build global research programmes.


OPN: Tell us more about your research looking at results from total and partial hip replacements?

MB: The research programme in hip fractures spans well over a decade, beginning with two partnered large-scale multinational randomised trials. The first evaluated different approaches to operative fixation of femoral neck fractures (FAITH trial) and the second examined alternative approaches to hip arthroplasty for femoral neck fractures (HEALTH trial). Published in the Lancet and New England Journal of Medicine, respectively, these two large randomised trails looked at thousands of patients worldwide and set new benchmarks for patient care. This decade-long journey involved several hundred surgeon investigators and researchers and garnered a recent Kappa Delta Award from the American Academy of Orthopaedic Surgeons for its impact. Briefly, these trials provided demonstrated equivalence between total hip arthroplasty and hem-arthoplasty at two years post-surgery in rates of secondary procedures and function. For those fractures requiring operative fixation, we learned that the sliding hip screw (a fixed angle device) was superior in displaced fractures, in smokers and in those fractures in which the fracture line was situated at the base of the femoral neck (basi-cervical fractures).


OPN: What are you working on now in your research?

MB: I’ve transitioned to asking large, simple questions that are of interest to a global community. Trauma is the leading cause of death in developing nations. In the past decade, a focus on road traffic safety aimed to reduce mortality by primary prevention strategies such as helmet and seatbelt use; however, there was a gap in knowledge regarding what factors predicted outcomes following road traffic crashes. In response to this, we have already recruited 36,000 patients across several continents in our INORMUS study (International Orthopaedic Multicenter Study in Trauma). We aim to determine the determinants of outcome in patients who sustain fractures in low/middle income countries. We are also planning a very large clinical trial of simple treatments to prevent infection in patients undergoing arthroplasty for hip and knee arthritis. We anticipate this trial will require 15,000–20,000 patients worldwide.


OPN: What has been the highlight of your career so far?

MB: When I look back, I can’t believe how quickly time has passed. I’ve been the recipient of so much kindness, help and, quite frankly, luck (timing is everything). However, my proudest moments have rarely been about my personal achievements; rather, it’s the growth and achievements of all those incredible students, residents, fellows, and faculty I’ve had the honour to work with. My highlight reel is really just the stories of the amazing accomplishments of all those individuals realising their true potential. To have been part of that story is my highlight.


OPN: If you weren’t an orthopaedic surgeon what would you be?

MB: Easy. An artist. In grade school I decided I wanted to be an artist. I loved sketching and drawing. My parents, however, didn’t quite see the vision. I believe that my love of art and a creative mindset has been instrumental in the way I think about problems, and how I solve problems. I’m now 50 years old, and have re-invested meaningful time into art. With a year of painting behind me, I’m now working towards my first exhibition in 2020. So everything did come full circle. My parents, by the way, will be the first people in the exhibit.


OPN: What would you tell your 21-year-old self?

MB: I’ve learned a lot of life lessons along the way but the ones I would definitely tell my younger self are best relayed in the acronym “THINK”: 1. Try new things (always keep a creative mindset), 2. Have fun (never forget this!) 3. Invest time in the 20 per cent (ie the 20 per cent of the things that give you 80 per cent of your satisfaction in life; Pareto Principle), 4. Never fear failure, embrace it (learning happens here) and 5. Know it’s okay to start again (life is about re-inventing yourself again and again).


OPN: Away from the clinic and operating theatre – what do you do to relax?

MB: I’ve found my best ideas come when I’m away from the noise of the city and into the forest trails on my bike. I’ve become an avid mountain biker, enjoying the singletrack trails at every city I visit. I’ve made it a requisite activity for meetings with graduate students and fellows. Affectionately called #virtualoffice meetings, I can be found in a forest bike ride with a student or fellow discussing their thesis, research or life. We live the by mantra: Reading, w(R)riting, and Riding.


OPN: How do you think the future looks in the field of orthopaedic surgery?

MB: Orthopaedic surgery is a rapidly evolving field. Change is coming fast, but this change is driven by data, and lots of it. I see the promise of bigger datasets on the horizon. Data is the new oil of the next decade. Those who own the data will own the narrative. But here’s the catch. Not all data is equal. Moreover, big data is useless if we cannot extract and analyse it to help surgeons and healthcare providers make better decisions for their patients. I’m committed to understanding the promise of bigger data for better decisions. That’s my focus in the coming years.